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Atrial arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy: Prevalence, echocardiographic predictors, and treatment

Introduction The clinical role of atrial arrhythmias (AA) in arrhythmogenic right ventricular cardiomyopathy (ARVC) and the echocardiographic variables that predict them are not well defined. We describe the prevalence, types, echocardiographic predictors, and management of AA in patients with ARVC....

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Published in:Journal of cardiovascular electrophysiology 2019-10, Vol.30 (10), p.1801-1810
Main Authors: Cardona‐Guarache, Ricardo, Åström‐Aneq, Meriam, Oesterle, Adam, Asirvatham, Roshini, Svetlichnaya, Jana, Marcus, Gregory M., Gerstenfeld, Edward P., Klein, Liviu, Scheinman, Melvin M.
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container_issue 10
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container_title Journal of cardiovascular electrophysiology
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creator Cardona‐Guarache, Ricardo
Åström‐Aneq, Meriam
Oesterle, Adam
Asirvatham, Roshini
Svetlichnaya, Jana
Marcus, Gregory M.
Gerstenfeld, Edward P.
Klein, Liviu
Scheinman, Melvin M.
description Introduction The clinical role of atrial arrhythmias (AA) in arrhythmogenic right ventricular cardiomyopathy (ARVC) and the echocardiographic variables that predict them are not well defined. We describe the prevalence, types, echocardiographic predictors, and management of AA in patients with ARVC. Methods We retrospectively evaluated medical records of 117 patients with definite ARVC (2010 Task Force Criteria) from two tertiary care centers. We identified those patients with sustained AA (>30 seconds), including atrial fibrillation (AF), atrial flutter (AFL), and atrial tachycardia (AT). We collected demographic, genetic, and clinical data. The median follow‐up was 3.4 years (interquartile range = 2.0‐5.7). Results Total 26 patients (22%) had one or more types of AA: AF (n = 19), AFL (n = 9), and AT (n = 8). We performed genetic testing on 84 patients with ARVC (71.8%). Two patients with AA (8%) had peripheral emboli, and one patient (4%) suffered inappropriate implantable cardioverter‐defibrillator shock. We performed catheter ablation of AA in eight patients (31%), with no procedural complications. Right atrial area and left atrial volume index were independently associated with increased odds of AA; odds ratio (OR), 1.1 (95% confidence interval [CI]:1.02‐1.16) (P = .01) and OR, 1.1 (95% CI:1.03‐1.15) (P = .003), respectively. An increase in tricuspid annular plane peak systolic excursion was independently associated with reduced odds; OR, 0.3 (95% CI: 0.1‐0.94) (P = .003). Conclusions Atrial arrhythmias (AA) are common in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Inappropriate shocks and systemic emboli may be associated with AA. Atrial size and right ventricular dysfunction may help identify patients with ARVC at increased odds of AA.
doi_str_mv 10.1111/jce.14069
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We describe the prevalence, types, echocardiographic predictors, and management of AA in patients with ARVC. Methods We retrospectively evaluated medical records of 117 patients with definite ARVC (2010 Task Force Criteria) from two tertiary care centers. We identified those patients with sustained AA (&gt;30 seconds), including atrial fibrillation (AF), atrial flutter (AFL), and atrial tachycardia (AT). We collected demographic, genetic, and clinical data. The median follow‐up was 3.4 years (interquartile range = 2.0‐5.7). Results Total 26 patients (22%) had one or more types of AA: AF (n = 19), AFL (n = 9), and AT (n = 8). We performed genetic testing on 84 patients with ARVC (71.8%). Two patients with AA (8%) had peripheral emboli, and one patient (4%) suffered inappropriate implantable cardioverter‐defibrillator shock. We performed catheter ablation of AA in eight patients (31%), with no procedural complications. Right atrial area and left atrial volume index were independently associated with increased odds of AA; odds ratio (OR), 1.1 (95% confidence interval [CI]:1.02‐1.16) (P = .01) and OR, 1.1 (95% CI:1.03‐1.15) (P = .003), respectively. An increase in tricuspid annular plane peak systolic excursion was independently associated with reduced odds; OR, 0.3 (95% CI: 0.1‐0.94) (P = .003). Conclusions Atrial arrhythmias (AA) are common in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Inappropriate shocks and systemic emboli may be associated with AA. Atrial size and right ventricular dysfunction may help identify patients with ARVC at increased odds of AA.</description><identifier>ISSN: 1045-3873</identifier><identifier>ISSN: 1540-8167</identifier><identifier>EISSN: 1540-8167</identifier><identifier>DOI: 10.1111/jce.14069</identifier><identifier>PMID: 31310380</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Ablation ; Arrhythmia ; arrhythmogenic right ventricular cardiomyopathy ; atrial arrhythmias ; atrial fibrillation ; atrial flutter ; Cardiac arrhythmia ; Cardiomyopathy ; Catheters ; Complications ; Demographics ; Electrocardiography ; Fibrillation ; Genetic screening ; Heart ; Medical instruments ; Medical records ; Patients ; Tachycardia ; Ventricle</subject><ispartof>Journal of cardiovascular electrophysiology, 2019-10, Vol.30 (10), p.1801-1810</ispartof><rights>2019 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3919-a81b56f004a6a43b8c4551cba10d8a009d2943b6d496d14f6e92e0f4bd0638683</citedby><cites>FETCH-LOGICAL-c3919-a81b56f004a6a43b8c4551cba10d8a009d2943b6d496d14f6e92e0f4bd0638683</cites><orcidid>0000-0002-4971-7016</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31310380$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-159891$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Cardona‐Guarache, Ricardo</creatorcontrib><creatorcontrib>Åström‐Aneq, Meriam</creatorcontrib><creatorcontrib>Oesterle, Adam</creatorcontrib><creatorcontrib>Asirvatham, Roshini</creatorcontrib><creatorcontrib>Svetlichnaya, Jana</creatorcontrib><creatorcontrib>Marcus, Gregory M.</creatorcontrib><creatorcontrib>Gerstenfeld, Edward P.</creatorcontrib><creatorcontrib>Klein, Liviu</creatorcontrib><creatorcontrib>Scheinman, Melvin M.</creatorcontrib><title>Atrial arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy: Prevalence, echocardiographic predictors, and treatment</title><title>Journal of cardiovascular electrophysiology</title><addtitle>J Cardiovasc Electrophysiol</addtitle><description>Introduction The clinical role of atrial arrhythmias (AA) in arrhythmogenic right ventricular cardiomyopathy (ARVC) and the echocardiographic variables that predict them are not well defined. We describe the prevalence, types, echocardiographic predictors, and management of AA in patients with ARVC. Methods We retrospectively evaluated medical records of 117 patients with definite ARVC (2010 Task Force Criteria) from two tertiary care centers. We identified those patients with sustained AA (&gt;30 seconds), including atrial fibrillation (AF), atrial flutter (AFL), and atrial tachycardia (AT). We collected demographic, genetic, and clinical data. The median follow‐up was 3.4 years (interquartile range = 2.0‐5.7). Results Total 26 patients (22%) had one or more types of AA: AF (n = 19), AFL (n = 9), and AT (n = 8). We performed genetic testing on 84 patients with ARVC (71.8%). Two patients with AA (8%) had peripheral emboli, and one patient (4%) suffered inappropriate implantable cardioverter‐defibrillator shock. We performed catheter ablation of AA in eight patients (31%), with no procedural complications. Right atrial area and left atrial volume index were independently associated with increased odds of AA; odds ratio (OR), 1.1 (95% confidence interval [CI]:1.02‐1.16) (P = .01) and OR, 1.1 (95% CI:1.03‐1.15) (P = .003), respectively. An increase in tricuspid annular plane peak systolic excursion was independently associated with reduced odds; OR, 0.3 (95% CI: 0.1‐0.94) (P = .003). Conclusions Atrial arrhythmias (AA) are common in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Inappropriate shocks and systemic emboli may be associated with AA. Atrial size and right ventricular dysfunction may help identify patients with ARVC at increased odds of AA.</description><subject>Ablation</subject><subject>Arrhythmia</subject><subject>arrhythmogenic right ventricular cardiomyopathy</subject><subject>atrial arrhythmias</subject><subject>atrial fibrillation</subject><subject>atrial flutter</subject><subject>Cardiac arrhythmia</subject><subject>Cardiomyopathy</subject><subject>Catheters</subject><subject>Complications</subject><subject>Demographics</subject><subject>Electrocardiography</subject><subject>Fibrillation</subject><subject>Genetic screening</subject><subject>Heart</subject><subject>Medical instruments</subject><subject>Medical records</subject><subject>Patients</subject><subject>Tachycardia</subject><subject>Ventricle</subject><issn>1045-3873</issn><issn>1540-8167</issn><issn>1540-8167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp1kU-P1CAYh4nRuOvowS9gSLxost2F0lLwNhnXf9lED-qVUPp2yqQtXaA76XfwQ8vadQ4mcgDC-7xPgB9CLym5pGlcHQxc0oJw-Qid07IgmaC8epz2pCgzJip2hp6FcCCEMk7Kp-iMUUYJE-Qc_dpGb3WPtffdErvB6oDtiCcdLYwx4KON3ano9jBag73ddxHfpbq3Zu61x0b7xrphcamvW97hbx7udA-jgQsMpnNrfe_11KX-yUNjTXQ-XGA9Njh60HFIuufoSav7AC8e1g368eH6--5TdvP14-fd9iYzTFKZaUHrkreEFJrrgtXCFGVJTa0paYQmRDa5TMe8KSRvaNFykDmQtqgbwpnggm1QtnrDEaa5VpO3g_aLctqq9_bnVjm_V72dFS2lkDTxb1Z-8u52hhDVYIOBvtcjuDmoPC_TJ1ckTRv0-h_04GY_pteonBFGq1xW98K3K2W8C8FDe7oCJeo-UpUiVX8iTeyrB-NcD9CcyL8ZJuBqBY62h-X_JvVld70qfwP31K1L</recordid><startdate>201910</startdate><enddate>201910</enddate><creator>Cardona‐Guarache, Ricardo</creator><creator>Åström‐Aneq, Meriam</creator><creator>Oesterle, Adam</creator><creator>Asirvatham, Roshini</creator><creator>Svetlichnaya, Jana</creator><creator>Marcus, Gregory M.</creator><creator>Gerstenfeld, Edward P.</creator><creator>Klein, Liviu</creator><creator>Scheinman, Melvin M.</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>7X8</scope><scope>ABXSW</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>DG8</scope><scope>ZZAVC</scope><orcidid>https://orcid.org/0000-0002-4971-7016</orcidid></search><sort><creationdate>201910</creationdate><title>Atrial arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy: Prevalence, echocardiographic predictors, and treatment</title><author>Cardona‐Guarache, Ricardo ; Åström‐Aneq, Meriam ; Oesterle, Adam ; Asirvatham, Roshini ; Svetlichnaya, Jana ; Marcus, Gregory M. ; Gerstenfeld, Edward P. ; Klein, Liviu ; Scheinman, Melvin M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3919-a81b56f004a6a43b8c4551cba10d8a009d2943b6d496d14f6e92e0f4bd0638683</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Ablation</topic><topic>Arrhythmia</topic><topic>arrhythmogenic right ventricular cardiomyopathy</topic><topic>atrial arrhythmias</topic><topic>atrial fibrillation</topic><topic>atrial flutter</topic><topic>Cardiac arrhythmia</topic><topic>Cardiomyopathy</topic><topic>Catheters</topic><topic>Complications</topic><topic>Demographics</topic><topic>Electrocardiography</topic><topic>Fibrillation</topic><topic>Genetic screening</topic><topic>Heart</topic><topic>Medical instruments</topic><topic>Medical records</topic><topic>Patients</topic><topic>Tachycardia</topic><topic>Ventricle</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cardona‐Guarache, Ricardo</creatorcontrib><creatorcontrib>Åström‐Aneq, Meriam</creatorcontrib><creatorcontrib>Oesterle, Adam</creatorcontrib><creatorcontrib>Asirvatham, Roshini</creatorcontrib><creatorcontrib>Svetlichnaya, Jana</creatorcontrib><creatorcontrib>Marcus, Gregory M.</creatorcontrib><creatorcontrib>Gerstenfeld, Edward P.</creatorcontrib><creatorcontrib>Klein, Liviu</creatorcontrib><creatorcontrib>Scheinman, Melvin M.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium &amp; Calcified Tissue Abstracts</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>SWEPUB Linköpings universitet full text</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SWEPUB Linköpings universitet</collection><collection>SwePub Articles full text</collection><jtitle>Journal of cardiovascular electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cardona‐Guarache, Ricardo</au><au>Åström‐Aneq, Meriam</au><au>Oesterle, Adam</au><au>Asirvatham, Roshini</au><au>Svetlichnaya, Jana</au><au>Marcus, Gregory M.</au><au>Gerstenfeld, Edward P.</au><au>Klein, Liviu</au><au>Scheinman, Melvin M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Atrial arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy: Prevalence, echocardiographic predictors, and treatment</atitle><jtitle>Journal of cardiovascular electrophysiology</jtitle><addtitle>J Cardiovasc Electrophysiol</addtitle><date>2019-10</date><risdate>2019</risdate><volume>30</volume><issue>10</issue><spage>1801</spage><epage>1810</epage><pages>1801-1810</pages><issn>1045-3873</issn><issn>1540-8167</issn><eissn>1540-8167</eissn><abstract>Introduction The clinical role of atrial arrhythmias (AA) in arrhythmogenic right ventricular cardiomyopathy (ARVC) and the echocardiographic variables that predict them are not well defined. We describe the prevalence, types, echocardiographic predictors, and management of AA in patients with ARVC. Methods We retrospectively evaluated medical records of 117 patients with definite ARVC (2010 Task Force Criteria) from two tertiary care centers. We identified those patients with sustained AA (&gt;30 seconds), including atrial fibrillation (AF), atrial flutter (AFL), and atrial tachycardia (AT). We collected demographic, genetic, and clinical data. The median follow‐up was 3.4 years (interquartile range = 2.0‐5.7). Results Total 26 patients (22%) had one or more types of AA: AF (n = 19), AFL (n = 9), and AT (n = 8). We performed genetic testing on 84 patients with ARVC (71.8%). Two patients with AA (8%) had peripheral emboli, and one patient (4%) suffered inappropriate implantable cardioverter‐defibrillator shock. We performed catheter ablation of AA in eight patients (31%), with no procedural complications. Right atrial area and left atrial volume index were independently associated with increased odds of AA; odds ratio (OR), 1.1 (95% confidence interval [CI]:1.02‐1.16) (P = .01) and OR, 1.1 (95% CI:1.03‐1.15) (P = .003), respectively. An increase in tricuspid annular plane peak systolic excursion was independently associated with reduced odds; OR, 0.3 (95% CI: 0.1‐0.94) (P = .003). Conclusions Atrial arrhythmias (AA) are common in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Inappropriate shocks and systemic emboli may be associated with AA. Atrial size and right ventricular dysfunction may help identify patients with ARVC at increased odds of AA.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>31310380</pmid><doi>10.1111/jce.14069</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-4971-7016</orcidid><oa>free_for_read</oa></addata></record>
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1540-8167
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subjects Ablation
Arrhythmia
arrhythmogenic right ventricular cardiomyopathy
atrial arrhythmias
atrial fibrillation
atrial flutter
Cardiac arrhythmia
Cardiomyopathy
Catheters
Complications
Demographics
Electrocardiography
Fibrillation
Genetic screening
Heart
Medical instruments
Medical records
Patients
Tachycardia
Ventricle
title Atrial arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy: Prevalence, echocardiographic predictors, and treatment
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