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.

doi:10.1111/jce.14069

Cited by 17 publications

(6 citation statements)

References 28 publications

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“…While the studies included in this review do not report phenotype of HF nor right‐sided involvement, studies examining atrial arrhythmias in arrhythmogenic cardiomyopathy with predominant right ventricular involvement may provide further insight. Among four studies of arrhythmogenic cardiomyopathy patients ( n = 36 to 294), 78–81 2–11% had documented AFL compared with 8–11% with AF, and 2–19% with both AF and AFL. Atrial arrhythmias were associated with either right‐sided or left‐sided ventricular dysfunction or chamber enlargement, but analyses among patients specifically with AFL were never reported.…”

Section: Discussionmentioning

confidence: 99%

Heart failure and atrial flutter: a systematic review of current knowledge and practices

et al. 2021

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While the interplay between heart failure (HF) and atrial fibrillation (AF) has been extensively studied, little is known regarding HF and atrial flutter (AFL), which may be managed differently. We reviewed the incidence, prevalence, and predictors of HF in AFL and vice versa, and the outcomes of treatment of AFL in HF. A systematic literature review of PubMed/Medline and EMBASE yielded 65 studies for inclusion and qualitative synthesis. No study described the incidence or prevalence of AFL in unselected patients with HF. Most cohorts enrolled patients with AF/AFL as interchangeable diagnoses, or highly selected patients with tachycardia‐induced cardiomyopathy. The prevalence of HF in AFL ranged from 6% to 56%. However, the phenotype of HF was never defined by left ventricular ejection fraction (LVEF). No studies reported the predictors, phenotype, and prognostic implications of AFL in HF. There was significant variation in treatments studied, including the proportion that underwent ablation. When systolic dysfunction was tachycardia‐mediated, catheter ablation demonstrated LVEF normalization in up to 88%, as well as reduced cardiovascular mortality. In summary, AFL and HF often coexist but are understudied, with no randomized trial data to inform care. Further research is warranted to define the epidemiology and establish optimal management.

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Section: Discussionmentioning

confidence: 99%

Heart failure and atrial flutter: a systematic review of current knowledge and practices

et al. 2021

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“…Catheter ablation (CA) is an effective therapy for the treatment of atrial arrhythmias in the general population [10,11]. Data regarding the use, safety, and efficacy of CA in the management of atrial arrhythmias in ARVC are scarce, and previous work is limited to a few small sample-sized reports [12,13]. Therefore, the aim of this international multicenter study was to analyze the efficacy and safety of CA for the treatment of atrial arrhythmias in patients with ARVC.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Catheter Ablation for Atrial Arrhythmias in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy—A Multicenter Study

Gasperetti

James

Liang

et al. 2021

JCM

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Background: Atrial arrhythmias are present in up to 20% of patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Catheter ablation (CA) is an effective treatment for atrial arrhythmias in the general population. Data regarding CA for atrial arrhythmias in ARVC are scarce. Objective: To assess the safety and efficacy of CA for atrial arrhythmias in patients with ARVC. Methods: In this international collaborative effort, all patients with a definite diagnosis of ARVC undergoing CA for atrial fibrillation (AF), focal atrial tachycardia (AT), or cavotricuspid isthmus (CTI)-dependent atrial flutter (AFl) were extracted from twelve ARVC registries. Demographic, periprocedural, and long-term arrhythmic outcome data were collected. Results: Thirty-seven patients were enrolled in the study (age 50.2 ± 16.6 years, male 84%, CHA2DS2VASc 1 (1,2), HAS-BLED 0 (0–2)). The arrhythmia leading to CA was AF in 23 (62%), focal left AT in 5 (14%), and CTI-dependent AFl in 9 (24%). Acute procedural success was achieved in all procedures but one (n = 1 focal left AT; 97% acute success). The median follow-up period was 27 (13–67) months, and 96%, 74%, and 61% of patients undergoing AF ablation were free from any atrial arrhythmia recurrence after a single procedure at 6 months, 12 months, and last follow-up, respectively. After focal AT ablation, freedom from atrial arrhythmia recurrence was 80%, 80%, and 60% at 6 months, 12 months, and last follow-up, respectively. All patients undergoing CTI ablation were free from atrial arrhythmia recurrences at 6 months, with 89% single-procedural arrhythmic freedom at last follow-up. One major complication (2.7%; PV stenosis requiring PV stenting) occurred. Conclusions: CA is safe and effective in managing atrial arrhythmias in patients with ARVC, with success rates comparable to the general population.

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“…Moreover, a cut-off value of 17.3% for the RV GLS and 1.35 per second for the RV global and atrial arrhythmias compared to those without atrial arrhythmias (Figures 3 and 4). RA area, LA volume index, RVOT diameter and TAPSE were associated with increased odds of having atrial arrhythmias, even after adjusting for age 13 . In 48 patients with ACM followed for 6-18 months, e' of the tricuspid valve annulus, peak E velocity of the mitral valve, septal e' at the mitral valve, RA area and volume, alongside with right ventricular myocardial performance index were strong predictors for major adverse cardiac events 14 .…”

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confidence: 88%

Multimodality imaging in arrhythmogenic cardiomyopathy

Țăpoi¹,

Clément²,

Radu³

et al. 2021

Romanian Journal of Cardiology

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Arrhythmogenic cardiomyopathy, as it has been recently redefi ned, is characterized by progressive myocyte loss with fibrosis and fat infiltration of the myocardium, which finally leads to a broad clinical spectrum ranging from heart failure symptoms to sudden cardiac death. The diagnosis of arrhythmogenic cardiomyopathy is challenging particularly because of its heterogeneity in presentation, which varies from focal right ventricular involvement to biventricular or prominent left ventricular phenotype. In the past decades, the development of new electrocardiographic and imaging diagnostic criteria for arrhythmogenic cardiomyopathy constituted an important area of research and resulted in the elaboration of the Padua criteria. However, even with the widespread availability of modern imaging techniques, there is still a lack of awareness in the health care community and this pathology persist in being under-or misdiagnosed. Given the limited indication of endomyocardial biopsy for the diagnosis of arrhythmogenic cardiomyopathy, one can conclude that the progress that has been made in the last few years in the multimodality imaging field is of utmost importance for the early detection and proper treatment of patients with arrhythmogenic cardiomyopathy, providing valuable prognostic information.

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

Cited by 17 publications

References 28 publications

Heart failure and atrial flutter: a systematic review of current knowledge and practices

Heart failure and atrial flutter: a systematic review of current knowledge and practices

Efficacy of Catheter Ablation for Atrial Arrhythmias in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy—A Multicenter Study

Multimodality imaging in arrhythmogenic cardiomyopathy

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