title: Usefulness of electrocardiographic parameters for risk prediction in arrhythmogenic right ventricular dysplasia.
abstract: The value of electrocardiographic findings predicting adverse outcome in patients with arrhythmogenic right ventricular dysplasia (ARVD) is not well known. We hypothesized that ventricular depolarization and repolarization abnormalities on the 12-lead surface electrocardiogram (ECG) predict adverse outcome in patients with ARVD. ECGs of 111 patients screened for the 2010 ARVD Task Force Criteria from 3 Swiss tertiary care centers were digitized and analyzed with a digital caliper by 2 independent observers blinded to the outcome. ECGs were compared in 2 patient groups: (1) patients with major adverse cardiovascular events (MACE: a composite of cardiac death, heart transplantation, survived sudden cardiac death, ventricular fibrillation, sustained ventricular tachycardia, or arrhythmic syncope) and (2) all remaining patients. A total of 51 patients (46%) experienced MACE during a follow-up period with median of 4.6 years (interquartile range 1.8 to 10.0). Kaplan-Meier analysis revealed reduced times to MACE for patients with repolarization abnormalities according to Task Force Criteria (p = 0.009), a precordial QRS amplitude ratio (∑QRS mV V1 to V3/∑QRS mV V1 to V6) of ≤ 0.48 (p = 0.019), and QRS fragmentation (p = 0.045). In multivariable Cox regression, a precordial QRS amplitude ratio of ≤ 0.48 (hazard ratio [HR] 2.92, 95% confidence interval [CI] 1.39 to 6.15, p = 0.005), inferior leads T-wave inversions (HR 2.44, 95% CI 1.15 to 5.18, p = 0.020), and QRS fragmentation (HR 2.65, 95% CI 1.1 to 6.34, p = 0.029) remained as independent predictors of MACE. In conclusion, in this multicenter, observational, long-term study, electrocardiographic findings were useful for risk stratification in patients with ARVD, with repolarization criteria, inferior leads TWI, a precordial QRS amplitude ratio of ≤ 0.48, and QRS fragmentation constituting valuable variables to predict adverse outcome.
authors.affiliation: Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland.
authors.forename: Ardan M
authors.initials: AM
authors.lastname: Saguner
authors.affiliation: Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Ganahl
authors.affiliation: Department of Cardiology, University Hospital Bern, Bern, Switzerland.
authors.forename: Samuel H
authors.initials: SH
authors.lastname: Baldinger
authors.affiliation: Division of Biostatistics, Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.
authors.forename: Andrea
authors.initials: A
authors.lastname: Kraus
authors.affiliation: Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland; Department of Cardiology, University Hospital Bern, Bern, Switzerland.
authors.forename: Argelia
authors.initials: A
authors.lastname: Medeiros-Domingo
authors.affiliation: Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Nordbeck
authors.affiliation: Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland.
authors.forename: Arhan R
authors.initials: AR
authors.lastname: Saguner
authors.affiliation: Department of Cardiology, Triemli Hospital Zurich, Switzerland.
authors.forename: Andreas S
authors.initials: AS
authors.lastname: Mueller-Burri
authors.affiliation: Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland.
authors.forename: Laurent M
authors.initials: LM
authors.lastname: Haegeli
authors.affiliation: Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland; Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wolber
authors.affiliation: Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Steffel
authors.affiliation: Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland.
authors.forename: Nazmi
authors.initials: N
authors.lastname: Krasniqi
authors.affiliation: Department of Cardiology, University Hospital Bern, Bern, Switzerland.
authors.forename: Etienne
authors.initials: E
authors.lastname: Delacrétaz
authors.affiliation: Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland; Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lüscher
authors.affiliation: Division of Biostatistics, Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.
authors.forename: Leonhard
authors.initials: L
authors.lastname: Held
authors.affiliation: Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland.
authors.forename: Corinna B
authors.initials: CB
authors.lastname: Brunckhorst
authors.affiliation: Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland; Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland. Electronic address: firat.duru@usz.ch.
authors.forename: Firat
authors.initials: F
authors.lastname: Duru
mesh_terms: D000328:Adult; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology*; D016001:Confidence Intervals; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends