Clinical role of atrial arrhythmias in patients with arrhythmogenic right ventricular dysplasia
Open accessAbstract
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.
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Identification of atrial arrhythmias in ARVD/C is important as it may herald inappropriate ICD therapy, and is associated with higher risk of heart transplantation and cardiac mortality.
“Identification of atrial arrhythmias is important as it may herald inappropriate ICD therapy, and is associated with a higher risk of heart transplantation and cardiac mortality in patients with ARVD/C”
From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Saguner et al., 2014
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Steinberg, J. S., Varma, N., Cygankiewicz, I., Aziz, P., Balsam, P., Baranchuk, A., Cantillon, D. J., Dilaveris, P., Dubner, S. J., El-Sherif, N., et al. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.03.038 · Cited by 303 · see citing works
- Authors
- Saguner, A. M., Ganahl, S., Kraus, A., Baldinger, S. H., Medeiros-Domingo, A., Saguner, A. R., Mueller-Burri, S. A., Wolber, T., Haegeli, L. M., Krasniqi, N., Tanner, F. C., Steffel, J., Brunckhorst, C., & Duru, F.
- Affiliations
- University of Zurich (CH)
- University Hospital of Bern (CH)
- Department of Cardiology, University Heart Center Zurich
- Triemli Hospital (CH)
- ORCID
- Venue
- Circulation Journal
- Publisher
- Japanese Circulation Society
- Published
- 2014
- Volume
- 78
- Issue
- 12
- Pages
- 2854-2861
- ISSN
- 1346-9843 (ISSN-L)
- 1347-4820
- OpenAlex
- W2089382085
- Cited by
- 39
- References
- 38
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 3 · 2023: 2 · 2022: 3 · 2021: 4 · 2020: 4 · 2019: 2 · 2018: 5 · 2017: 7 · 2016: 3 · 2015: 1 · 2014: 2
- FWCI
- 2.97
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- Circulation Journal (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
- Bern Open Repository and Information System (University of Bern) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- Georg und Bertha Schwyzer-Winiker-Stiftung
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Keywords
- arrhythmogenic right ventricular cardiomyopathy, atrial fibrillation, atrial flutter, atrial arrhythmias, risk prediction, right ventricular fractional area change, left atrial diameter, right atrial diameter, heart transplantation, cardiovascular mortality, transthoracic echocardiography, electrocardiogram
- MeSH terms
- Adult, Atrial Fibrillation, Atrial Flutter, Echocardiography, Electrocardiography, Female, Follow-Up Studies, Humans, Male, Middle Aged, Registries, Switzerland, Prevalence, Heart Transplantation, Defibrillators, Implantable, Arrhythmogenic Right Ventricular Dysplasia, Kaplan-Meier Estimate
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