title: Malignant ventricular arrhythmias in alcoholic cardiomyopathy.
abstract: BACKGROUND
  Excessive alcohol consumption is a well-known aetiology of atrial arrhythmias but there is little information concerning the prevalence or incidence of malignant ventricular arrhythmias in alcoholic cardiomyopathy (ACM). This study sought to investigate incidence and predictive factors of ventricular arrhythmias in ACM.
  
  
  METHODS
  Retrospective observational study of the clinical characteristics and long-term arrhythmic events in 282 consecutive patients with ACM (94 individuals) and idiopathic dilated cardiomyopathy (IDCM) (188 individuals) evaluated between 1993 and 2011.
  
  
  RESULTS
  During a median follow-up of 38months (IQR:12-77), 42 patients died and 79 underwent heart transplantation [31 (33%) with ACM vs 90 (48%) with IDCM; p=0.017]. A total of 37 (13%) patients [18 (19%) ACM vs 20 (11%) IDCM; p=0.048] suffered malignant ventricular arrhythmias. On multivariate analysis, left bundle branch block (LBBB) (OR 2.4; CI95%: 1.2-5; p=0.015) and alcoholic aetiology (OR 2.3; CI95%: 1.1-4.5; p=0.026) were the only independent predictors of malignant ventricular arrhythmic events. A total of 18 (19%) ACM patients experienced 20 malignant ventricular arrhythmic events (4 aborted SCD, 8 SCD and 8 appropriate ICD therapies). At baseline evaluation, the only independent predictor of malignant ventricular arrhythmias in ACM patients was LBBB (OR 11.2; CI95%: 2.6-50; p=0.001). No malignant ventricular arrhythmias were recorded during follow-up in ACM patients if left ventricular ejection fraction (LVEF) had increased or remained ≥40%.
  
  
  CONCLUSIONS
  Malignant ventricular arrhythmias are more frequent in ACM than in IDCM. LBBB identifies ACM patients with increased risk of SCD. No malignant ventricular arrhythmias were found during follow-up in ACM patients when LVEF was ≥40%.
authors.affiliation: Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; Department of Cardiology, Hospital General de Villalba, Madrid, Spain. Electronic address: gonzaloguzzo@yahoo.es.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Guzzo-Merello
authors.affiliation: Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain. Electronic address: fdominguezrodriguez@gmail.com.
authors.forename: Fernando
authors.initials: F
authors.lastname: Dominguez
authors.affiliation: Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; Myocardial Biology Programme, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain. Electronic address: esthgonzalez@hotmail.com.
authors.forename: Esther
authors.initials: E
authors.lastname: González-López
authors.affiliation: Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain. Electronic address: martacobomarcos@hotmail.com.
authors.forename: Marta
authors.initials: M
authors.lastname: Cobo-Marcos
authors.affiliation: Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain. Electronic address: mgomezbueno@secardiologia.es.
authors.forename: Manuel
authors.initials: M
authors.lastname: Gomez-Bueno
authors.affiliation: Arrhythmia Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain. Electronic address: ilozano@vitanet.nu.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Fernandez-Lozano
authors.affiliation: Biostatistics Unit, Hospital Universitario Puerta de Hierro, Madrid, Spain. Electronic address: isabel.millan@salud.madrid.org.
authors.forename: Isabel
authors.initials: I
authors.lastname: Millan
authors.affiliation: Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain. Electronic address: jsecu@telefonica.net.
authors.forename: Javier
authors.initials: J
authors.lastname: Segovia
authors.affiliation: Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain. Electronic address: luispulpon@secardiologia.es.
authors.forename: Luis
authors.initials: L
authors.lastname: Alonso-Pulpon
authors.affiliation: Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; Myocardial Biology Programme, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain. Electronic address: pablogpavia@yahoo.es.
authors.forename: Pablo
authors.initials: P
authors.lastname: Garcia-Pavia
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications*; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000503:physiopathology; D053840:Brugada Syndrome / Q000150:complications / Q000503:physiopathology; D002037:Bundle-Branch Block / Q000150:complications; D000075224:Cardiac Conduction System Disease; D002310:Cardiomyopathy, Alcoholic / Q000150:complications* / Q000453:epidemiology; D002311:Cardiomyopathy, Dilated / Q000503:physiopathology*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D004562:Electrocardiography / Q000379:methods; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D064887:Observational Studies as Topic; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D014463:Ultrasonography; D016277:Ventricular Function, Left / Q000502:physiology
keywords: Alcohol; Alcoholic cardiomyopathy; Arrhythmia; Sudden cardiac death