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Prognostic impact of atrio-ventricular conduction abnormalities in non-ischemic cardiomyopathy

Javier Sanaú1, Andrea Di Marco1, Pamela Brown2

  • 1Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain.

Heart Rhythm
|July 30, 2025
PubMed

Insights

Atrioventricular block (AVB) predicts ventricular arrhythmias (VA) in non-ischemic cardiomyopathy (NICM), especially when combined with late gadolinium enhancement (LGE). This finding aids risk stratification for sudden cardiac death.

Area of Science:

  • Cardiology
  • Cardiac Imaging
  • Electrophysiology

Background:

  • Late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) aids ventricular arrhythmia (VA) prediction in non-ischemic cardiomyopathy (NICM).
  • Risk stratification within LGE-positive (LGE+) NICM patients remains challenging.
  • Atrioventricular block (AVB) is a potential VA predictor, but contemporary data are limited.

Purpose of the Study:

  • To evaluate the prognostic significance of AVB in a current cohort of NICM patients undergoing CMR.
  • To determine if AVB improves risk stratification for VA in NICM.

Main Methods:

  • Retrospective cohort study of 616 NICM patients.
  • Assessment of AVB via electrocardiogram (ECG) and LGE via CMR.
  • Primary endpoint: VA (arrhythmia events, sudden death); Secondary endpoint: heart failure (HF) events.

Main Results:

  • AVB occurred in 9% of patients, associated with lower LVEF and higher LGE prevalence.
  • AVB independently predicted VA events (HR 2.7, P=.007) alongside LGE and LVEF.
  • In LGE+ patients, AVB significantly increased VA risk (aHR 3.4, P<.001).
  • AVB did not predict HF events (P=.11).

Conclusions:

  • AVB is a strong, independent predictor of VA and sudden death in NICM, complementing LGE and LVEF.
  • AVB significantly refines risk stratification in LGE+ NICM patients.
  • AVB identifies a subgroup of NICM patients at extremely high risk for arrhythmias.
Abstract

Keywords:
Atrioventricular blockCardiac magnetic resonanceLate gadolinium enhancementNon-ischemic cardiomyopathySudden deathVentricular arrhythmias

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