title: Ventricular arrhythmias in the North American multidisciplinary study of ARVC: predictors, characteristics, and treatment.
abstract: BACKGROUND
  Arrhythmogenic right ventricular cardiomyopathy (ARVC) is associated with sudden cardiac death. However, the selection of patients for implanted cardioverter-defibrillators (ICDs), as well as programming of the ICD, is unclear.
  
  
  OBJECTIVE
  The objective of this study was to identify predictors, characteristics, and treatment of ventricular arrhythmias in patients with ARVC.
  
  
  METHODS
  The Multidisciplinary Study of Right Ventricular Cardiomyopathy established the North American ARVC Registry and enrolled patients with a diagnosis of ARVC. Patients were followed prospectively.
  
  
  RESULTS
  Of 137 patients enrolled, 108 received ICDs. Forty-eight patients had 502 sustained episodes of ventricular arrhythmias, including 489 that were monomorphic and 13 that were polymorphic. In the patients with ICDs, independent predictors of ventricular arrhythmias in follow-up included spontaneous sustained ventricular arrhythmias before ICD implantation and T-wave inversions inferiorly. The only independent predictor for life-threatening arrhythmias, defined as sustained ventricular tachycardia (VT) ≥240 beats/min or ventricular fibrillation, was a younger age at enrollment. Anti-tachycardia pacing (ATP), independent of the cycle length of the VT, was successful in terminating 92% of VT episodes.
  
  
  CONCLUSIONS
  In the North American ARVC Registry, the majority of ventricular arrhythmias in follow-up are monomorphic. Risk factors for ventricular arrhythmias were spontaneous ventricular arrhythmias before enrollment and a younger age at ICD implantation. ATP is highly successful in terminating VT, and all ICDs should be programmed for ATP, even for rapid VT.
authors.affiliation: Tufts Medical Center, Cardiac Arrhythmia Center, Boston, Massachusetts. Electronic address: mlink@tuftsmedicalcenter.org.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Link
authors.affiliation: Tufts Medical Center, Cardiac Arrhythmia Center, Boston, Massachusetts.
authors.forename: Douglas
authors.initials: D
authors.lastname: Laidlaw
authors.affiliation: Heart Research Follow-up Program, Cardiology Division, University of Rochester Medical Center, Rochester, New York.
authors.forename: Bronislava
authors.initials: B
authors.lastname: Polonsky
authors.affiliation: Heart Research Follow-up Program, Cardiology Division, University of Rochester Medical Center, Rochester, New York.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Zareba
authors.affiliation: Heart Research Follow-up Program, Cardiology Division, University of Rochester Medical Center, Rochester, New York.
authors.forename: Scott
authors.initials: S
authors.lastname: McNitt
authors.affiliation: Section of Cardiology, University of Arizona, Tucson, Arizona.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Gear
authors.affiliation: Section of Cardiology, University of Arizona, Tucson, Arizona.
authors.forename: Frank
authors.initials: F
authors.lastname: Marcus
authors.affiliation: Tufts Medical Center, Cardiac Arrhythmia Center, Boston, Massachusetts.
authors.forename: N A Mark
authors.initials: NA
authors.lastname: Estes
mesh_terms: D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D017147:Defibrillators, Implantable; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D015994:Incidence; D008297:Male; D009656:North America / Q000453:epidemiology; D011379:Prognosis; D012042:Registries; D015996:Survival Rate / Q000639:trends; D017180:Tachycardia, Ventricular / Q000150:complications / Q000453:epidemiology* / Q000628:therapy
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: arrhythmogenic right ventricular cardiomyopathy; implantable cardioverter-defibrillator; ventricular arrhythmia; ventricular tachycardia