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

Ricardo Cardona-Guarache, Meriam Åström-Aneq, Adam Oesterle, Roshini Asirvatham, Jana Svetlichnaya, Gregory M. Marcus, Edward P. Gerstenfeld, Liviu Klein, Melvin M. Scheinman

Research output: Contribution to journalArticle

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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 (>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.

Original languageEnglish (US)
Pages (from-to)1801-1810
Number of pages10
JournalJournal of Cardiovascular Electrophysiology
Volume30
Issue number10
DOIs
StatePublished - Oct 1 2019
Externally publishedYes

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Arrhythmogenic Right Ventricular Dysplasia
Cardiac Arrhythmias
Therapeutics
Atrial Flutter
Odds Ratio
Confidence Intervals
Embolism
Tachycardia
Atrial Fibrillation
Shock
Right Ventricular Dysfunction
Catheter Ablation
Implantable Defibrillators
Genetic Testing
Advisory Committees
Tertiary Care Centers
Medical Records
Demography

Keywords

  • arrhythmogenic right ventricular cardiomyopathy
  • atrial arrhythmias
  • atrial fibrillation
  • atrial flutter

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Atrial arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy : Prevalence, echocardiographic predictors, and treatment. / Cardona-Guarache, Ricardo; Åström-Aneq, Meriam; Oesterle, Adam; Asirvatham, Roshini; Svetlichnaya, Jana; Marcus, Gregory M.; Gerstenfeld, Edward P.; Klein, Liviu; Scheinman, Melvin M.

In: Journal of Cardiovascular Electrophysiology, Vol. 30, No. 10, 01.10.2019, p. 1801-1810.

Research output: Contribution to journalArticle

Cardona-Guarache, R, Åström-Aneq, M, Oesterle, A, Asirvatham, R, Svetlichnaya, J, Marcus, GM, Gerstenfeld, EP, Klein, L & Scheinman, MM 2019, 'Atrial arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy: Prevalence, echocardiographic predictors, and treatment', Journal of Cardiovascular Electrophysiology, vol. 30, no. 10, pp. 1801-1810. https://doi.org/10.1111/jce.14069
Cardona-Guarache, Ricardo ; Åström-Aneq, Meriam ; Oesterle, Adam ; Asirvatham, Roshini ; Svetlichnaya, Jana ; Marcus, Gregory M. ; Gerstenfeld, Edward P. ; Klein, Liviu ; Scheinman, Melvin M. / Atrial arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy : Prevalence, echocardiographic predictors, and treatment. In: Journal of Cardiovascular Electrophysiology. 2019 ; Vol. 30, No. 10. pp. 1801-1810.
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T1 - Atrial arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy

T2 - Prevalence, echocardiographic predictors, and treatment

AU - Cardona-Guarache, Ricardo

AU - Åström-Aneq, Meriam

AU - Oesterle, Adam

AU - Asirvatham, Roshini

AU - Svetlichnaya, Jana

AU - Marcus, Gregory M.

AU - Gerstenfeld, Edward P.

AU - Klein, Liviu

AU - Scheinman, Melvin M.

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N2 - 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.

AB - 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.

KW - arrhythmogenic right ventricular cardiomyopathy

KW - atrial arrhythmias

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KW - atrial flutter

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