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Alblaihed L, Kositz C, Brady WJ, Al-Salamah T, Mattu A. Diagnosis and management of arrhythmogenic right ventricular cardiomyopathy. Am J Emerg Med 2023; 65:146-153. [PMID: 36638611 DOI: 10.1016/j.ajem.2022.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic disorder of the myocardium that can lead to ventricular arrhythmia and sudden cardiac death. The condition has been identified as a significant cause of arrhythmic death among young people and athletes, therefore, early recognition of the disease by emergency clinicians is critical to prevent subsequent death. The diagnosis of ARVC can be very challenging and requires a systematic approach. This publication reviews the pathophysiology, classification, clinical presentations, and appropriate approach to diagnosis and management of ARVC.
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Affiliation(s)
- Leen Alblaihed
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 S Paca Street, 6(th) Floor, Suite 200, Baltimore, MD 21201, United States of America.
| | - Christine Kositz
- Depratment of Emergency Medicine, University of Maryland Shore Medical Center at Easton, 219 S Washington St, Easton, MD 21601, United States of America
| | - William J Brady
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Tareq Al-Salamah
- Department of Emergency Medicine, College of Medicine, King Saud University, PO Box 7805, Riyadh 11472, Saudi Arabia
| | - Amal Mattu
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 S Paca Street, 6(th) Floor, Suite 200, Baltimore, MD 21201, United States of America
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2
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Rimac G, Poulakos N, Beaulieu-Shearer A, Dupuis C, Beaudoin J, Lemay S, Lalancette JS, Trahan S, Racine HP, Steinberg C, Sénéchal M, Turgeon PY. Clinical and echocardiographic evolution of patients with arrhythmogenic cardiomyopathy before heart transplantation. Clin Transplant 2023; 37:e14869. [PMID: 36447131 DOI: 10.1111/ctr.14869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/17/2022] [Accepted: 11/24/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Arrhythmogenic cardiomyopathy (ACM) is an inherited cardiomyopathy characterized by fibrofatty myocardial replacement, and accurate diagnosis can be challenging. The clinical course of patients expressing a severe phenotype of the disease needing heart transplantation (HTx) is not well described in the literature. Therefore, this study aims to describe the clinical and echocardiographic evolution of patients with ACM necessitating HTx. METHODS We retrospectively studied all patients who underwent HTx in our institution between 1998 and 2019 with a definite diagnosis of ACM according to the explanted heart examination. RESULTS Ten patients with confirmed ACM underwent HTx. Only four of them had a diagnosis of ACM before HTx. These patients were 28 ± 15 years old at the time of their first symptoms. Patients received a diagnosis of heart failure (HF) after 5.9 ± 8.7 years of symptom evolution. The mean age at transplantation was 40 ± 17 years old. All the patients experienced ventricular tachycardia (VT) at least once before their HTx and 50% were resuscitated after sudden death. The mean left ventricular ejection at diagnosis and before transplantation was similar (32% ± 21% vs. 35.0% ± 19.3%, p = NS). Right ventricular dysfunction was present in all patients at the time of transplantation. CONCLUSION Patients with ACM necessitating HTx show a high burden of ventricular arrhythmias and frequently present a biventricular involvement phenotype, making early diagnosis challenging. HF symptoms are the most frequent reason leading to the decision to transplant.
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Affiliation(s)
- Goran Rimac
- Department of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec, Québec, Canada
| | | | | | - Céline Dupuis
- Department of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec, Québec, Canada
| | - Jonathan Beaudoin
- Department of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec, Québec, Canada
| | - Sylvain Lemay
- Department of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec, Québec, Canada
| | - Jean-Simon Lalancette
- Department of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec, Québec, Canada
| | - Sylvain Trahan
- Department of Pathology, Institut Universitaire de Cardiologie et Pneumologie de Québec, Québec, Canada
| | - Hugo-Pierre Racine
- Department of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec, Québec, Canada
| | - Christian Steinberg
- Department of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec, Québec, Canada
| | - Mario Sénéchal
- Department of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec, Québec, Canada
| | - Pierre Yves Turgeon
- Department of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec, Québec, Canada
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3
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Unexplained Syncope With Abnormal ECG Findings in the Emergency Department: Don't Miss the Epsilon Wave! Adv Emerg Nurs J 2023; 45:51-58. [PMID: 36757748 DOI: 10.1097/tme.0000000000000448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Arrhythmogenic cardiomyopathy (AC) is a genetic cardiac disorder associated with sudden cardiac death, specifically in young adults (D. Corrado, C. Basso, & D. Judge, 2017). AC is a disease of the heart muscle fibers and it is not usually diagnosed until its advanced stages. Typical AC presentation in the emergency department (ED) includes cardiac syncope, palpitations, ventricular arrhythmias, or resolved cardiac arrest. The epsilon wave is the hallmark and the major electrocardiographic (ECG) diagnostic criterion for AC in the later stages of the disease process (A. R. Perez-Riera et al., 2019). A definite diagnosis of AC is of high complexity and not typically made by emergency providers; however, many cases of advanced AC are discovered in the ED as a result of syncope. The purpose of this case review is to discuss the typical presentation, ECG findings, and emergency providers' role in the management of patients with suspected AC.
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Petruescu L, Lebreton G, Coutance G, Maupain C, Fressart V, Badenco N, Waintraub X, Duthoit G, Laredo M, Himbert C, Hidden-Lucet F, Leprince P, Varnous S, Gandjbakhch E. Clinical course of arrhythmogenic right ventricular cardiomyopathy with end-stage heart failure and outcome after heart transplantation. Arch Cardiovasc Dis 2023; 116:9-17. [PMID: 36609000 DOI: 10.1016/j.acvd.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Few data exist on the characteristics and outcomes of patients with arrhythmogenic right ventricular cardiomyopathy and advanced heart failure who undergo heart transplantation. AIM To explore the pretransplant course and outcomes of patients with arrhythmogenic right ventricular cardiomyopathy after heart transplantation. METHODS This observational retrospective monocentric study included all consecutive patients with arrhythmogenic right ventricular cardiomyopathy who underwent heart transplantation during a 13-year period (2006-2019) at Pitié-Salpêtrière University Hospital (Paris). RESULTS A total of 23 patients with arrhythmogenic right ventricular cardiomyopathy underwent heart transplantation between 2006 and 2019. The median time from diagnosis to heart transplantation was 9 years, and the median age at transplantation was 50 years. At diagnosis, half of the patients had left ventricular dysfunction, 59% had extensive T-wave inversion and 43% had a history of sustained ventricular tachycardia. Only five patients were involved in intensive sport activity. Indications for heart transplantation were end-stage biventricular dysfunction in 13 patients, end-stage right ventricular heart failure in seven and electrical storm in three. Only three patients had pulmonary hypertension, and half of the patients had atrial arrhythmias. The survival rate 1 year after heart transplantation was 74% (95% confidence interval 53-88%). Eight patients experienced primary graft dysfunction needing extracorporeal membrane oxygenation. CONCLUSIONS Patients with arrhythmogenic right ventricular cardiomyopathy who eventually needed heart transplantation mostly exhibited extended disease with biventricular dysfunction at diagnosis. Intensive sport activity did not seem to be a major determinant. Advanced heart failure usually occurred late in the course of the disease. Primary graft dysfunction after heart transplantation was frequent, and should be anticipated. Additional data are needed to identify the optimal timing for heart transplantation and predictors of end-stage heart failure in patients with arrhythmogenic right ventricular cardiomyopathy.
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Affiliation(s)
- Laura Petruescu
- APHP, Département de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Fondation ICAN, 75013 Paris, France; Diagnosis and Therapeutic Center, Hôpital Hôtel-Dieu, AP-HP, université de Paris, 75004 Paris, France
| | - Guillaume Lebreton
- Sorbonne Université, 75013, Paris, France; Diagnosis and Therapeutic Center, Hôpital Hôtel-Dieu, AP-HP, université de Paris, 75004 Paris, France
| | - Guillaume Coutance
- Sorbonne Université, 75013, Paris, France; Diagnosis and Therapeutic Center, Hôpital Hôtel-Dieu, AP-HP, université de Paris, 75004 Paris, France
| | - Carole Maupain
- APHP, Département de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Fondation ICAN, 75013 Paris, France
| | - Véronique Fressart
- APHP, Service de Biochimie Métabolique, UF cardiogénétique et myogénétique moléculaire et cellulaire, centre hospitalier universitaire Pitié-Salpêtrière, 75013 Paris, France
| | - Nicolas Badenco
- APHP, Département de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Fondation ICAN, 75013 Paris, France
| | - Xavier Waintraub
- APHP, Département de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Fondation ICAN, 75013 Paris, France
| | - Guillaume Duthoit
- APHP, Département de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Fondation ICAN, 75013 Paris, France
| | - Mikael Laredo
- APHP, Département de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Fondation ICAN, 75013 Paris, France
| | - Caroline Himbert
- APHP, Département de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Fondation ICAN, 75013 Paris, France
| | - Francoise Hidden-Lucet
- APHP, Département de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Fondation ICAN, 75013 Paris, France
| | - Pascal Leprince
- Sorbonne Université, 75013, Paris, France; APHP, Département de Chirurgie Cardiaque, Centre Hospitalier Universitaire Pitié-Salpêtrière, 75013 Paris, France
| | - Shaida Varnous
- APHP, Département de Chirurgie Cardiaque, Centre Hospitalier Universitaire Pitié-Salpêtrière, 75013 Paris, France
| | - Estelle Gandjbakhch
- APHP, Département de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Fondation ICAN, 75013 Paris, France; Sorbonne Université, 75013, Paris, France.
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Bonios MJ, Armenis I, Kogerakis N, Thodou A, Gkouziouta A, Koliopoulou A, Kaklamanis L, Chamogeorgakis T, Drakos SG, Adamopoulos SN. Phenotype Characterization and Course of Patients With Arrhythmogenic Right Ventricular Cardiomyopathy and Biventricular Advanced Heart Failure: A Report of 3 Cases. Transplant Proc 2022; 54:2347-2351. [PMID: 36195497 DOI: 10.1016/j.transproceed.2022.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC) may be complicated by heart failure. Management of advanced heart failure in this context is challenging. METHODS We reviewed our center's experience with advanced heart failure therapies in patients with ARVC. Three rapidly deteriorating patients with ARVC with biventricular heart failure were found. Their management and outcomes are presented. Data on ventricular fibrosis were available in 2 of them and are also included. RESULTS The first patient underwent initially successful paracorporeal pulsatile biventricular assist device (BiVAD) implantation. However, a large ischemic stroke occurred 2 weeks later, and the patient died after 2 months. The second patient underwent urgent BiVAD implantation after extracorporeal membrane oxygenation support because of cardiogenic shock, but his course was complicated by multiorgan failure due to systemic infection and the patient died. The last patient, being at Interagency Registry for Mechanically Assisted Circulatory Support 3-4 profile, underwent heart transplant with uneventful recovery. Extensive fibrosis was present in both ventricles of 2 patients undergoing pathology examination. CONCLUSIONS Patients with ARVC and advanced biventricular heart failure are characterized by extensive ventricular fibrosis and considerable risk, but data on their management are limited. Biventricular circulatory support is associated with suboptimal outcomes, and prioritization for heart transplant seems preferable.
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Affiliation(s)
- Michael J Bonios
- Heart Failure and Transplant Units, Onassis Cardiac Surgery Center, Athens, Greece.
| | - Iakovos Armenis
- Heart Failure and Transplant Units, Onassis Cardiac Surgery Center, Athens, Greece
| | - Nektarios Kogerakis
- Heart Failure and Transplant Units, Onassis Cardiac Surgery Center, Athens, Greece
| | - Aspasia Thodou
- Division of Cardiovascular Medicine, University of Utah Health and School of Medicine, Salt Lake City, Utah
| | - Angeliki Gkouziouta
- Heart Failure and Transplant Units, Onassis Cardiac Surgery Center, Athens, Greece
| | - Antigoni Koliopoulou
- Heart Failure and Transplant Units, Onassis Cardiac Surgery Center, Athens, Greece
| | - Loukas Kaklamanis
- Heart Failure and Transplant Units, Onassis Cardiac Surgery Center, Athens, Greece
| | | | - Stavros G Drakos
- Division of Cardiovascular Medicine, University of Utah Health and School of Medicine, Salt Lake City, Utah
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Maitz TN, Gupta R, Persin K, Sundlof DW. Utilization of sacubitril-valsartan for right ventricular failure in a patient with arrhythmogenic right ventricular cardiomyopathy. Future Cardiol 2022; 18:547-552. [PMID: 35703395 DOI: 10.2217/fca-2021-0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Arrhythmogenic right ventricular (RV) cardiomyopathy is an autosomal dominant inherited cardiomyopathy that is characterized by an increased risk of ventricular arrhythmias, sudden cardiac death and, less commonly, heart failure. The authors present the case of a 36-year-old woman with familial lamin cardiomyopathy with positive LMNA mutation and genetic testing revealing LMNA and TMEM43 mutations consistent with arrhythmogenic RV cardiomyopathy. The patient presented with clinical signs of RV failure. Transthoracic echocardiogram showed newly reduced RV function in the absence of left ventricular involvement. Cardiac MRI demonstrated diffuse late gadolinium enhancement of the mid-level and apical RV anterior free wall. Diuretics were started, and sacubitril-valsartan was added when the patient's symptoms persisted. Diuretics were then discontinued, and sacubitril-valsartan was the primary therapy. This is the first reported case of symptomatic and imaging-proven RV recovery in a patient with symptomatic RV failure in the setting of arrhythmogenic RV cardiomyopathy treated with sacubitril-valsartan.
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Affiliation(s)
- Theresa N Maitz
- Department of Internal Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Rahul Gupta
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA, USA
| | - Kathryn Persin
- Department of the Sciences, Dartmouth University, Hanover, NH 03755, USA
| | - Deborah W Sundlof
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA, USA
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7
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Arrhythmogenic Right Ventricular Cardiomyopathy. JACC Clin Electrophysiol 2022; 8:533-553. [PMID: 35450611 DOI: 10.1016/j.jacep.2021.12.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 01/21/2023]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) encompasses a group of conditions characterized by right ventricular fibrofatty infiltration, with a predominant arrhythmic presentation. First described in the late 1970s and early 1980s, it is now frequently recognized to have biventricular involvement. The prevalence is ∼1:2,000 to 1:5,000, depending on geographic location, and it has a slight male predominance. The diagnosis of ARVC is determined on the basis of fulfillment of task force criteria incorporating electrophysiological parameters, cardiac imaging findings, genetic factors, and histopathologic features. Risk stratification of patients with ARVC aims to identify those who are at increased risk of sudden cardiac death or sustained ventricular tachycardia. Factors including age, sex, electrophysiological features, and cardiac imaging investigations all contribute to risk stratification. The current management of ARVC includes exercise restriction, β-blocker therapy, consideration for implantable cardioverter-defibrillator insertion, and catheter ablation. This review summarizes our current understanding of ARVC and provides clinicians with a practical approach to diagnosis and management.
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8
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Tennyson CD, Yapejian R. Arrhythmogenic Right Ventricular Cardiomyopathy: Overview and Case Study. AACN Adv Crit Care 2022; 33:14-22. [PMID: 35259221 DOI: 10.4037/aacnacc2022384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
This article provides a broad overview of arrhythmogenic right ventricular cardiomyopathy, including evaluation, diagnosis, and treatment options. Nursing considerations and clinical management are reviewed through the lens of a case study. Early diagnosis to prevent sudden cardiac death is essential for patients with arrhythmogenic right ventricular cardiomyopathy.
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Affiliation(s)
- Carolina D Tennyson
- Carolina D. Tennyson is a Nurse Practitioner specializing in the advanced heart failure population at the Duke Heart Center, Durham, North Carolina, and an Assistant Professor at Duke University School of Nursing, 307 Trent Drive, Office 3112, Durham, NC 27710
| | - Rebecca Yapejian
- Rebecca Yapejian is a Nurse Practitioner specializing in clinical cardiac electrophysiology and implantable cardiac device management at the Duke Heart Center, Durham, North Carolina
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Giuliano K, Scheel P, Etchill E, Fraser CD, Suarez-Pierre A, Hsu S, Wittstein IS, Kasper EK, Florido R, Tandri H, Calkins H, Choi CW, Sharma K, Kilic A, Gilotra NA. Heart transplantation outcomes in arrhythmogenic right ventricular cardiomyopathy: a contemporary national analysis. ESC Heart Fail 2022; 9:988-997. [PMID: 35132806 PMCID: PMC8934952 DOI: 10.1002/ehf2.13687] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/27/2021] [Accepted: 10/09/2021] [Indexed: 01/06/2023] Open
Abstract
Aims Heart failure is an increasingly recognized later stage manifestation of arrhythmogenic right ventricular cardiomyopathy (ARVC) that can require heart transplantation (HT) to appropriately treat. We aimed to study contemporary ARVC HT outcomes in a national registry. Methods and results The United Network for Organ Sharing registry was queried for HT recipients from 1/1994 through 2/2020. ARVC patients were compared with non‐ARVC dilated, restrictive, and hypertrophic cardiomyopathy HT patients (HT for ischaemic and valvular disease was excluded from analysis). Post‐HT survival was assessed using Kaplan–Meier estimates. A total of 189 of 252 (75%) waitlisted ARVC patients (median age 48 years, 65% male) underwent HT, representing 0.3% of the total 65 559 HT during the study time period. Annual frequency of HT for ARVC increased significantly over time. ARVC patients had less diabetes (5% vs. 17%, P < 0.001), less cigarette use (15% vs. 23%, P < 0.001), lower pulmonary artery and pulmonary capillary wedge pressures, and lower cardiac output than the 33 659 non‐ARVC patients (P < 0.001). Ventricular assist device use was significantly lower in ARVC patients (8% vs. 32%, P < 0.001); 1 and 5 year post‐HT survival was 97% and 93% for ARVC vs. 95% and 82% for non‐ARVC HT recipients (P < 0.001). On adjusted multivariable Cox regression, ARVC had decreased risk of post‐HT death compared with non‐ARVC aetiologies (hazard ratio 0.48, 95% confidence interval 0.28–0.82, P = 0.008). Patients with ARVC also had lower risk of death or graft failure than non‐ARVC patients (hazard ratio 0.51, 95% confidence interval 0.32–0.81, P = 0.004). Conclusions In the largest series of HT in ARVC, we found that HT is increasingly performed in ARVC, with higher survival compared with other cardiomyopathy aetiologies. The right ventricular predominant pathophysiology may require unique considerations for heart failure management, including HT.
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Affiliation(s)
- Katherine Giuliano
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul Scheel
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eric Etchill
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles D Fraser
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Steven Hsu
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ilan S Wittstein
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Edward K Kasper
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Roberta Florido
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Harikrishna Tandri
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chun W Choi
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kavita Sharma
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ahmet Kilic
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nisha A Gilotra
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Scheel PJ, Giuliano K, Tichnell C, James C, Murray B, Tandri H, Carter D, Fehr T, Umapathi P, Vaishnav J, Lewsey SC, Hsu S, Calkins H, Sharma K, Choi CW, Gilotra NA, Kilic A. Heart transplantation strategies in arrhythmogenic right ventricular cardiomyopathy: a tertiary ARVC centre experience. ESC Heart Fail 2021; 9:1008-1017. [PMID: 34953065 PMCID: PMC8934913 DOI: 10.1002/ehf2.13757] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/13/2021] [Accepted: 11/25/2021] [Indexed: 12/21/2022] Open
Abstract
Aims Methods and results Conclusions
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Affiliation(s)
- Paul J. Scheel
- Division of Cardiology, Department of Medicine Johns Hopkins School of Medicine Baltimore MD USA
| | - Katherine Giuliano
- Division of Cardiac Surgery, Department of Surgery Johns Hopkins School of Medicine Baltimore MD USA
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine Johns Hopkins School of Medicine Baltimore MD USA
| | - Cynthia James
- Division of Cardiology, Department of Medicine Johns Hopkins School of Medicine Baltimore MD USA
| | - Brittney Murray
- Division of Cardiology, Department of Medicine Johns Hopkins School of Medicine Baltimore MD USA
| | - Harikrishna Tandri
- Division of Cardiology, Department of Medicine Johns Hopkins School of Medicine Baltimore MD USA
| | - Debra Carter
- Division of Cardiology, Department of Medicine Johns Hopkins School of Medicine Baltimore MD USA
| | - Tracey Fehr
- Division of Cardiology, Department of Medicine Johns Hopkins School of Medicine Baltimore MD USA
| | - Priya Umapathi
- Division of Cardiology, Department of Medicine Johns Hopkins School of Medicine Baltimore MD USA
| | - Joban Vaishnav
- Division of Cardiology, Department of Medicine Johns Hopkins School of Medicine Baltimore MD USA
| | - Sabra C. Lewsey
- Division of Cardiology, Department of Medicine Johns Hopkins School of Medicine Baltimore MD USA
| | - Steven Hsu
- Division of Cardiology, Department of Medicine Johns Hopkins School of Medicine Baltimore MD USA
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine Johns Hopkins School of Medicine Baltimore MD USA
| | - Kavita Sharma
- Division of Cardiology, Department of Medicine Johns Hopkins School of Medicine Baltimore MD USA
| | - Chun Woo Choi
- Division of Cardiac Surgery, Department of Surgery Johns Hopkins School of Medicine Baltimore MD USA
| | - Nisha A. Gilotra
- Division of Cardiology, Department of Medicine Johns Hopkins School of Medicine Baltimore MD USA
| | - Ahmet Kilic
- Division of Cardiac Surgery, Department of Surgery Johns Hopkins School of Medicine Baltimore MD USA
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Heart Failure in Patients with Arrhythmogenic Cardiomyopathy. J Clin Med 2021; 10:jcm10204782. [PMID: 34682905 PMCID: PMC8540844 DOI: 10.3390/jcm10204782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/10/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a rare inherited cardiomyopathy characterized as fibro-fatty replacement, and a common cause for sudden cardiac death in young athletes. Development of heart failure (HF) has been an under-recognized complication of ACM for a long time. The current clinical management guidelines for HF in ACM progression have nowadays been updated. Thus, a comprehensive review for this great achievement in our understanding of HF in ACM is necessary. In this review, we aim to describe the research progress on epidemiology, clinical characteristics, risk stratification and therapeutics of HF in ACM.
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12
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Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC), also called arrhythmogenic right ventricular dysplasia or arrhythmogenic cardiomyopathy, is a genetic disease characterised by progressive myocyte loss with replacement by fibrofatty tissue. This structural change leads to the prominent features of ARVC of ventricular arrhythmia and increased risk for sudden cardiac death (SCD). Emphasis should be placed on determining and stratifying the patient’s risk of ventricular arrhythmia and SCD. ICDs should be used to treat the former and prevent the latter, but ICDs are not benign interventions. ICDs come with their own complications in this overall young population of patients. This article reviews the literature regarding the factors that contribute to the assessment of risk stratification in ARVC patients.
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Affiliation(s)
- Ryan Wallace
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institute, Baltimore, MD, US
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institute, Baltimore, MD, US
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13
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Vischer AS, Castelletti S, Syrris P, McKenna WJ, Pantazis A. Heart failure in patients with arrhythmogenic right ventricular cardiomyopathy: Genetic characteristics. Int J Cardiol 2019; 286:99-103. [PMID: 30765282 DOI: 10.1016/j.ijcard.2019.01.065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 12/11/2018] [Accepted: 01/21/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetically determined heart muscle disorder. The incidence of heart failure (HF) in ARVC has been reported at 5-13%. We aimed to define the genotype and disease progression of ARVC patients with HF. METHODS Patients with a definite diagnosis of ARVC who underwent genetic testing were consecutively recruited. Detailed clinical data was collected at baseline and during follow up. Clinical endpoint was a composite of heart transplantation and death due to HF. RESULTS 135 patients were included. 8 (5.9%) patients reached the endpoint. Patients reaching the endpoint were significantly more likely to carry a Plakophilin 2 mutation than patients without HF, and 50% had multiple variants, however only one patient had 2 pathogenic mutations. CONCLUSIONS HF is a rare but significant outcome of patients with a definite diagnosis of ARVC. Patients with HF predominantly carried Plakophilin 2 mutations and often had multiple variants. RV dysfunction appears to be a determinant of heart transplantation and death.
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Affiliation(s)
- Annina S Vischer
- Medical Outpatient Department, University Hospital Basel, Basel, Switzerland.
| | - Silvia Castelletti
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmia of Genetic Origin, Milan, Italy
| | - Petros Syrris
- Institute of Cardiovascular Science, University College of London, London, United Kingdom
| | - William J McKenna
- Institute of Cardiovascular Science, University College of London, London, United Kingdom
| | - Antonios Pantazis
- Cardiomyopathy Service, Royal Brompton Hospital, London, United Kingdom
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Wang W, James CA, Calkins H. Diagnostic and therapeutic strategies for arrhythmogenic right ventricular dysplasia/cardiomyopathy patient. Europace 2019; 21:9-21. [PMID: 29688316 PMCID: PMC6321962 DOI: 10.1093/europace/euy063] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/16/2018] [Indexed: 12/21/2022] Open
Abstract
Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is a rare inherited heart muscle disease characterized by ventricular tachyarrhythmia, predominant right ventricular dysfunction, and sudden cardiac death. Its pathophysiology involves close interaction between genetic mutations and exposure to physical activity. Mutations in genes encoding desmosomal protein are the most common genetic basis. Genetic testing plays important roles in diagnosis and screening of family members. Syncope, palpitation, and lightheadedness are the most common symptoms. The 2010 Task Force Criteria is the standard for diagnosis today. Implantation of a defibrillator in high-risk patients is the only therapy that provides adequate protection against sudden death. Selection of patients who are best candidates for defibrillator implantation is challenging. Exercise restriction is critical in affected individuals and at-risk family members. Antiarrhythmic drugs and ventricular tachycardia ablation are valuable but palliative components of the management. This review focuses on the current diagnostic and therapeutic strategies in ARVD/C and outlines the future area of development in this field.
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Affiliation(s)
- Weijia Wang
- Division of Cardiology, Department of Medicine, Johns Hopkins University, 600 N. Wolfe Street, Sheikh Zayed Tower 7125R, Baltimore, MD, USA
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins University, 600 N. Wolfe Street, Sheikh Zayed Tower 7125R, Baltimore, MD, USA
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, 600 N. Wolfe Street, Sheikh Zayed Tower 7125R, Baltimore, MD, USA
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Gilljam T, Haugaa KH, Jensen HK, Svensson A, Bundgaard H, Hansen J, Dellgren G, Gustafsson F, Eiskjær H, Andreassen AK, Sjögren J, Edvardsen T, Holst AG, Svendsen JH, Platonov PG. Heart transplantation in arrhythmogenic right ventricular cardiomyopathy — Experience from the Nordic ARVC Registry. Int J Cardiol 2018; 250:201-206. [DOI: 10.1016/j.ijcard.2017.10.076] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/30/2017] [Accepted: 10/18/2017] [Indexed: 01/19/2023]
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