title: Clinical role of atrial arrhythmias in patients with arrhythmogenic right ventricular dysplasia.
abstract: BACKGROUND
  The clinical role of atrial fibrillation/atrial flutter (AF-AFl) and variables predicting these arrhythmias are not well defined in patients with arrhythmogenic right ventricular dysplasia (ARVD). We hypothesized that transthoracic echocardiography (TTE) and 12-lead electrocardiography (ECG) would be helpful in predicting AF-AFl in these patients. METHODS AND RESULTS: ECGs and TTEs of 90 patients diagnosed with definite or borderline ARVD (2010 Task Force Criteria) were analyzed. Data were compared in (1) patients with AF-AFl and (2) all other patients. A total of 18 (20%) patients experienced AF-AFl during a median follow-up of 5.8 years (interquartile range 2.0-10.4). Kaplan-Meier analysis revealed reduced times to AF-AFl among patients with echocardiographic RV fractional area change <27% (P<0.001), left atrial diameter ≥24.4 mm/m(2)(parasternal long-axis, P=0.001), and right atrial short-axis diameter ≥22.1 mm/m(2)(apical 4-chamber view, P=0.05). From all ECG variables, P mitrale conferred the highest hazard ratio (3.37, 95% confidence interval 0.92-12.36, P=0.067). Five patients with AF-AFl experienced inappropriate implantable cardioverter-defibrillator (ICD) shocks compared with 4 without AF-AFl (36% vs. 9%, P=0.03). AF-AFl was more prevalent in heart-transplant patients and those who died of cardiac causes (56% vs. 16%, P=0.014).
  
  
  CONCLUSIONS
  AF-AFl is associated with inappropriate ICD shocks, heart transplantation, and cardiac death in patients with ARVD. Evidence of reduced RV function and atrial dilation helps to identify the ARVD patients at increased risk for AF-AFl.
authors.affiliation: Department of Cardiology, University Heart Center Zurich.
authors.forename: Ardan M
authors.initials: AM
authors.lastname: Saguner
authors.forename: Sabrina
authors.initials: S
authors.lastname: Ganahl
authors.forename: Andrea
authors.initials: A
authors.lastname: Kraus
authors.forename: Samuel H
authors.initials: SH
authors.lastname: Baldinger
authors.forename: Argelia
authors.initials: A
authors.lastname: Medeiros-Domingo
authors.forename: Arhan R
authors.initials: AR
authors.lastname: Saguner
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Mueller-Burri
authors.forename: Thomas
authors.initials: T
authors.lastname: Wolber
authors.forename: Laurent M
authors.initials: LM
authors.lastname: Haegeli
authors.forename: Nazmi
authors.initials: N
authors.lastname: Krasniqi
authors.forename: Felix C
authors.initials: FC
authors.lastname: Tanner
authors.forename: Jan
authors.initials: J
authors.lastname: Steffel
authors.forename: Corinna
authors.initials: C
authors.lastname: Brunckhorst
authors.forename: Firat
authors.initials: F
authors.lastname: Duru
mesh_terms: D000328:Adult; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D001281:Atrial Fibrillation / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D001282:Atrial Flutter / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D017147:Defibrillators, Implantable; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012042:Registries; D013557:Switzerland / Q000453:epidemiology