Performance of the 2015 International Task Force Consensus Statement Risk Stratification Algorithm for Implantable Cardioverter-Defibrillator Placement in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy.
Background: Ventricular arrhythmias are a feared complication of arrhythmogenic right ventricular dysplasia/cardiomyopathy. In 2015, an International Task Force Consensus Statement proposed a risk stratification algorithm for implantable cardioverter-defibrillator placement in arrhythmogenic right v...
| Publicado en: | Circulation: Arrhythmia & Electrophysiology Vol. 11; no. 2; pp. 1 - 11 |
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| Autores principales: | , , , , , , , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Lippincott Williams & Wilkins
Feb2018
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=128104740&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 128104740 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 19413149 6CUA jtl: Circulation: Arrhythmia & Electrophysiology issn: 19413149 maglogo: N pubinfo: dt: Feb2018 vid: 11 iid: 2 pid: 433 pub: Lippincott Williams & Wilkins place: Baltimore, Maryland artinfo: ui: 128104740 128104740 NLM29453325 128104740 10.1161/CIRCEP.117.005593 NLM29453325 128104740 ppf: 1 ppct: 10 formats: tig: atl: Performance of the 2015 International Task Force Consensus Statement Risk Stratification Algorithm for Implantable Cardioverter-Defibrillator Placement in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy. aug: au: Orgeron, Gabriela M. te Riele, Anneline Tichnell, Crystal Weijia Wang Murray, Brittney Bhonsale, Aditya Judge, Daniel P. Kamel, Ihab R. Zimmerman, Stephan L. Tandri, Harikrishna Calkins, Hugh James, Cynthia A. Wang, Weijia affil: Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD sug: subj: Ventricular Fibrillation Prevention and Control Consensus Arrhythmogenic Right Ventricular Dysplasia Therapy Risk Assessment Methods Algorithms Defibrillators, Implantable Preventive Health Care Standards Male Prospective Studies Adult Arrhythmogenic Right Ventricular Dysplasia Complications Female Data Collection Human Ventricular Fibrillation Etiology Arrhythmogenic Right Ventricular Dysplasia Physiopathology Risk Factors Ventricular Fibrillation Epidemiology United States Validation Studies Comparative Studies Evaluation Research Multicenter Studies Adult: 19-44 years Male Female ab: Background: Ventricular arrhythmias are a feared complication of arrhythmogenic right ventricular dysplasia/cardiomyopathy. In 2015, an International Task Force Consensus Statement proposed a risk stratification algorithm for implantable cardioverter-defibrillator placement in arrhythmogenic right ventricular dysplasia/cardiomyopathy.Methods and Results: To evaluate performance of the algorithm, 365 arrhythmogenic right ventricular dysplasia/cardiomyopathy patients were classified as having a Class I, IIa, IIb, or III indication per the algorithm at baseline. Survival free from sustained ventricular arrhythmia (VT/VF) in follow-up was the primary outcome. Incidence of ventricular fibrillation/flutter cycle length <240 ms was also assessed. Two hundred twenty-four (61%) patients had a Class I implantable cardioverter-defibrillator indication; 80 (22%), Class IIa; 54 (15%), Class IIb; and 7 (2%), Class III. During a median 4.2 (interquartile range, 1.7-8.4)-year follow-up, 190 (52%) patients had VT/VF and 60 (16%) had ventricular fibrillation/flutter. Although the algorithm appropriately differentiated risk of VT/VF, incidence of VT/VF was underestimated (observed versus expected: 29.6 [95% confidence interval, 25.2-34.0] versus >10%/year Class I; 15.5 [confidence interval 11.1-21.6] versus 1% to 10%/year Class IIa). In addition, the algorithm did not differentiate survival free from ventricular fibrillation/flutter between Class I and IIa patients (P=0.97) or for VT/VF in Class I and IIa primary prevention patients (P=0.22). Adding Holter results (<1000 premature ventricular contractions/24 hours) to International Task Force Consensus classification differentiated risks.Conclusions: While the algorithm differentiates arrhythmic risk well overall, it did not distinguish ventricular fibrillation/flutter risks of patients with Class I and IIa implantable cardioverter-defibrillator indications. Limited differentiation was seen for primary prevention cases. As these are vital uncertainties in clinical decision-making, refinements to the algorithm are suggested prior to implementation. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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