PMID- 28633348 OWN - NLM STAT- MEDLINE DCOM- 20190409 LR - 20190409 IS - 1532-2092 (Electronic) IS - 1099-5129 (Linking) VI - 20 IP - FI1 DP - 2018 Jun 1 TI - Lifelong arrhythmic risk stratification in arrhythmogenic right ventricular cardiomyopathy: distribution of events and impact of periodical reassessment. PG - f20-f29 LID - 10.1093/europace/eux093 [doi] AB - AIMS: The arrhythmic risk stratification of arrhythmogenic right ventricular cardiomyopathy (ARVC) remains controversial. We evaluated the long-term distribution of life-threatening arrhythmic events assessing the impact of periodical risk reassessment. METHODS AND RESULTS: Ninety-eight ARVC patients with no previous major ventricular arrhythmias were retrospectively analysed. Patients were assessed at baseline, at 22 [inter-quartile range (IQR) 16-26], 49 (IQR 41-55) and 97 months (IQR 90-108). The primary endpoint was a composite of sudden cardiac death, ventricular fibrillation, sustained ventricular tachycardia or appropriate implanted cardioverter-defibrillator intervention. During a median follow-up of 91 months (IQR 34-222) 28 patients (29%) experienced the composite endpoint. The median time for the primary event was 35 months (IQR 18-86 months), and 39% of events occurred beyond 49 months of follow-up. History of syncope (HR 4.034; 95% CI, 1.488 to 10.932; P-value = 0.006), non-sustained ventricular tachycardia (NSVT; HR 3.534; 95% CI 1.265-9.877; P-value = 0.016), premature ventricular contractions (PVC) >1000/24h (HR 2.761; 95% CI 1.120-6.807; P-value = 0.027), and right ventricular fractional area change (RVFAC; HR 0.945; 95% CI 0.906-0.985; P-value = 0.008) were found as independent predictors at baseline multivariate analysis. Nevertheless, when the prognostic impact of each variable was reassessed overtime only NSVT (HR 3.282; 95% CI, 1.122 to 9.598, P-value = 0.023) and RVFAC (HR 0.351, 95% CI, 0.157 to 0.780; P-value = 0.010) remained independent predictors throughout the whole follow-up. CONCLUSION: In our cohort of ARVC patients only NSVT and RVFAC maintained their independent prognostic impact in predicting arrhythmic events during the long-term follow-up. Periodical re-assessment of risk in these patients is strongly recommended. FAU - Cappelletto, Chiara AU - Cappelletto C AD - Department of Cardiology, University Hospital "Ospedali Riuniti", SC Cardiologia, Polo Cardiologico, Ospedale di Cattinara, Via Valdoni 7, 34100 Trieste, Italy. FAU - Stolfo, Davide AU - Stolfo D AD - Department of Cardiology, University Hospital "Ospedali Riuniti", SC Cardiologia, Polo Cardiologico, Ospedale di Cattinara, Via Valdoni 7, 34100 Trieste, Italy. FAU - De Luca, Antonio AU - De Luca A AD - Department of Cardiology, University Hospital "Ospedali Riuniti", SC Cardiologia, Polo Cardiologico, Ospedale di Cattinara, Via Valdoni 7, 34100 Trieste, Italy. FAU - Pinamonti, Bruno AU - Pinamonti B AD - Department of Cardiology, University Hospital "Ospedali Riuniti", SC Cardiologia, Polo Cardiologico, Ospedale di Cattinara, Via Valdoni 7, 34100 Trieste, Italy. FAU - Barbati, Giulia AU - Barbati G AD - Department of Cardiology, University Hospital "Ospedali Riuniti", SC Cardiologia, Polo Cardiologico, Ospedale di Cattinara, Via Valdoni 7, 34100 Trieste, Italy. AD - Cardiovascular Center, Azienda per i Servizi Sanitari n. 1 (A.S.S. 1) of Trieste, Italy. FAU - Pivetta, Alberto AU - Pivetta A AD - Department of Cardiology, University Hospital "Ospedali Riuniti", SC Cardiologia, Polo Cardiologico, Ospedale di Cattinara, Via Valdoni 7, 34100 Trieste, Italy. FAU - Gobbo, Marco AU - Gobbo M AD - Department of Cardiology, University Hospital "Ospedali Riuniti", SC Cardiologia, Polo Cardiologico, Ospedale di Cattinara, Via Valdoni 7, 34100 Trieste, Italy. FAU - Brun, Francesca AU - Brun F AD - Department of Cardiology, University Hospital "Ospedali Riuniti", SC Cardiologia, Polo Cardiologico, Ospedale di Cattinara, Via Valdoni 7, 34100 Trieste, Italy. FAU - Merlo, Marco AU - Merlo M AD - Department of Cardiology, University Hospital "Ospedali Riuniti", SC Cardiologia, Polo Cardiologico, Ospedale di Cattinara, Via Valdoni 7, 34100 Trieste, Italy. FAU - Sinagra, Gianfranco AU - Sinagra G AD - Department of Cardiology, University Hospital "Ospedali Riuniti", SC Cardiologia, Polo Cardiologico, Ospedale di Cattinara, Via Valdoni 7, 34100 Trieste, Italy. LA - eng PT - Journal Article PT - Observational Study PL - England TA - Europace JT - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology JID - 100883649 RN - 0 (Anti-Arrhythmia Agents) SB - IM MH - *Action Potentials/drug effects MH - Adult MH - Anti-Arrhythmia Agents/therapeutic use MH - Arrhythmogenic Right Ventricular Dysplasia/*complications/diagnosis/physiopathology/therapy MH - Death, Sudden, Cardiac/etiology/prevention & control MH - Defibrillators, Implantable MH - Electric Countershock/instrumentation MH - Electrocardiography MH - Female MH - *Heart Rate/drug effects MH - Heart Ventricles/drug effects/*physiopathology MH - Humans MH - Male MH - Middle Aged MH - Predictive Value of Tests MH - Registries MH - Retrospective Studies MH - Risk Assessment MH - Risk Factors MH - Tachycardia, Ventricular/diagnosis/*etiology/physiopathology/prevention & control MH - Time Factors MH - Treatment Outcome MH - Ventricular Fibrillation/diagnosis/*etiology/physiopathology/prevention & control MH - Young Adult EDAT- 2017/06/22 06:00 MHDA- 2019/04/10 06:00 CRDT- 2017/06/22 06:00 PHST- 2016/12/08 00:00 [received] PHST- 2017/03/15 00:00 [accepted] PHST- 2017/06/22 06:00 [pubmed] PHST- 2019/04/10 06:00 [medline] PHST- 2017/06/22 06:00 [entrez] AID - 3867695 [pii] AID - 10.1093/europace/eux093 [doi] PST - ppublish SO - Europace. 2018 Jun 1;20(FI1):f20-f29. doi: 10.1093/europace/eux093.