Key result
In patients with ARVC, appropriate ICD shocks occurred in 54.7% over a median 7.9 years, with physical activity, inflammation, and hypokalaemia being the most common reversible triggers.
Why the study?
ICDs prevent sudden cardiac death in ARVC, but assessing the cumulative burden, evolution, and potential triggers of appropriate ICD shocks during long-term follow-up was needed to refine individual arrhythmic risk.
Cohort (n=53)
Yes
In patients with ARVC and an ICD, appropriate shocks are common and frequently associated with reversible triggers like physical activity, inflammation, and hypokalaemia.
May support addressing reversible triggers to reduce shocks in ARVC; hypothesis-generating, needs prospective confirmation.
INTRODUCTION: Implantable cardioverter-defibrillators (ICDs) can prevent sudden cardiac death due to ventricular arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). The aim of our study was to assess the cumulative burden, evolution and potential triggers of appropriate ICD shocks during long-term follow-up, which may help to reduce and further refine individual arrhythmic risk in this challenging disease. METHODS: This retrospective cohort study included 53 patients with definite ARVC according to the 2010 Task Force Criteria from the multicentre Swiss ARVC Registry with an implanted ICD for primary or secondary prevention. Follow-up was conducted by assessing all available patient records from patient visits, hospitalisations, blood samples, genetic analysis, as well as device interrogation and tracings. RESULTS: Fifty-three patients (male 71.7%, mean age 43±2.2 years, genotype positive 58.5%) were analysed during a median follow-up of 7.9 (IQR 10) years. In 29 (54.7%) patients, 177 appropriate ICD shocks associated with 71 shock episodes occurred. Median time to first appropriate ICD shock was 2.8 (IQR 3.6) years. Long-term risk of shocks remained high throughout long-term follow-up. Shock episodes occurred mainly during daytime (91.5%, n=65) and without seasonal preference. We identified potentially reversible triggers in 56 of 71 (78.9%) appropriate shock episodes, the main triggers representing physical activity, inflammation and hypokalaemia. CONCLUSION: The long-term risk of appropriate ICD shocks in patients with ARVC remains high during long-term follow-up. Ventricular arrhythmias occur more often during daytime, without seasonal preference. Reversible triggers are frequent with the most common triggers for appropriate ICD shocks being physical activity, inflammation and hypokalaemia in this patient population.
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Molitor et al. (2023) conducted a cohort in arrhythmogenic right ventricular cardiomyopathy (n=53). Implantable cardioverter-defibrillators (ICDs) was evaluated on appropriate ICD shocks. In patients with ARVC, appropriate ICD shocks occurred in 54.7% over a median 7.9 years, with physical activity, inflammation, and hypokalaemia being the most common reversible triggers.
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