Is ICD Implantation Useful in Patients with Arrhythmogenic Right-ventricular Cardiomyopathy?
The natural history of arrhythmogenic right-ventricular cardiomyopathy / dysplasia (ARVC/D) is closely related to ventricular electrical instability, which can precipitate sudden arrhythmic death, mostly in adolescents and young adults [1–4]. Heart failure is rare, and occurs later during the disease course as a result of progression of the right-ventricular disease and left-ventricular involvement . ARVC/D has become an emerging indication for implantablecardioverter defibrillator (ICD) to prevent sudden arrhythmic death in the setting of cardiomyopathy . Although there is definitive clinical evidence that ICD is the most effective therapy for both primary and secondary prevention of sudden death in patients with coronary artery disease [6–8], there are very few published data on the efficacy and safety of such a therapy in patients with ARVC/D, mostly because of the relatively low prevalence of the disease in the general population and the relatively low event rate [9–11]. Current indications for ICD implantation in patients with arrhythmogenic right-ventricular cardiomyopathy / dysplasia are empiric, being based widely on the experience gained by different centers using analogies with other conditions requiring antiarrhythmic therapy . Since the identification of clinical findings that predict clinical outcome has remained elusive, there is a gathering tendency to implant a ICD indiscriminately once the disease has been diagnosed, regardless of risk stratification .
KeywordsArrhythmogenic Right Ventricular Dysplasia Antitachycardia Pace Antiarrhythmic Versus Implantable Defibrillator Sudden Arrhythmic Death Unstable Ventricular Tachycardia
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- 13.Corrado D, Leoni L, Link M et al (2003) Implantable cardioverter-defibrillator therapy for primary and secondary prevention of sudden death in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia (abstract). Eur Heart J 24: (in press)Google Scholar