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Increased atrial vulnerability in arrhythmogenic right ventricular disease
B Brembilla-Perrot1, L Jacquemin, P Houplon
1Cardiology A, CHU of Brabois, Vandoeuvre les Nancy, France.
American Heart Journal
|May 20, 1998
Summary
Supraventricular tachyarrhythmias (SVTA) are common in arrhythmogenic right ventricular dysplasia (ARVD). This study found SVTA is inducible in 69% of ARVD patients, suggesting a diffuse myocardial disorder.
Area of Science:
- Cardiology
- Electrophysiology
- Genetics
Background:
- Arrhythmogenic right ventricular dysplasia (ARVD) is an inherited cardiomyopathy.
- Supraventricular tachyarrhythmias (SVTA) are known to occur in ARVD patients.
- The incidence and electrophysiological significance of SVTA in ARVD require further elucidation.
Purpose of the Study:
- To determine the incidence of inducible SVTA in patients diagnosed with ARVD.
- To compare SVTA inducibility in ARVD patients versus a healthy control group.
- To investigate the potential of SVTA as an early marker for ARVD progression.
Main Methods:
- Programmed atrial and ventricular stimulation protocols were employed in 47 ARVD patients and 36 controls.
- Stimulation was performed under control conditions and after isoproterenol administration.
- Induction of sustained SVTA (>1 minute) was the primary endpoint.
Main Results:
- Sustained SVTA was induced in 69% of ARVD patients without a history of SVTA, compared to 5.5% in controls (p < 0.001).
- Isoproterenol facilitated ventricular tachycardia induction in 11 of 27 ARVD patients.
- Two ARVD patients with inducible SVTA but no prior history later developed spontaneous SVTA.
Conclusions:
- ARVD is associated with a significantly higher incidence of inducible SVTA than in the general population.
- Inducible SVTA may precede the development of ventricular arrhythmias in ARVD.
- The findings support the hypothesis of a diffuse myocardial substrate in ARVD, manifesting as both ventricular and supraventricular arrhythmias.