Outcome of cardioverter-defibrillator implant in patients with arrhythmogenic right ventricular cardiomyopathy

• Published in: Heart and vessels 2007-05, Vol.22 (3), p.184-192
• Main Authors: Boriani, Giuseppe, Artale, Paolo, Biffi, Mauro, Martignani, Cristian, Frabetti, Lorenzo, Valzania, Cinzia, Diemberger, Igor, Ziacchi, Matteo, Bertini, Matteo, Rapezzi, Claudio, Parlapiano, Mario, Branzi, Angelo
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anti-Arrhythmia Agents - therapeutic use; Arrhythmogenic Right Ventricular Dysplasia - therapy; Cardiac arrhythmia; Cardiovascular disease; Clinical outcomes; Combined Modality Therapy; Defibrillators, Implantable - adverse effects; Female; Humans; Male; Middle Aged; Survival Rate; Transplants & implants; Treatment Outcome
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-006-0963-8

The aim of the present study was to investigate outcomes of implantable cardioverter-defibrillator (ICD) treatment in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). We reviewed baseline/follow-up data of 15 consecutive ARVC patients (mean age 55 +/- 15 years) and 30 randomly drawn patients with coronary artery disease (CAD) (mean age 60 +/- 10 years) with matching durations of follow-up (all implanted with ICDs for primary/secondary prevention of sudden death). At implant, appropriate placement of the RV lead was more difficult in ARVC patients. During follow-up (median 41 months), appropriate interventions for any ventricular tachyarrhythmias occurred in 8 (53%) ARVC patients and 17 (57%) CAD patients, but the occurrence of high rate (>240 beats/min) ventricular tachyarrhythmias was higher in ARVC patients. Inappropriate ICD interventions occurred in 5 (33%) ARVC patients and 10 (33%) CAD patients. Lead-related adverse events requiring surgical revision occurred in 7 (47%) ARVC patients as compared with 4 (13%) CAD patients (P = 0.0004). While ICD implantation is highly effective for prevention of sudden death in ARVC, it does carry elevated burdens of long-term lead-related adverse events. These findings underline the need of careful follow-up in ARVC aimed at early recognition of complications that can impair ICD function.