Comparing clinical performance of current implantable cardioverter-defibrillator implantation recommendations in arrhythmogenic right ventricular cardiomyopathy

Bosman, L.P.; Gerlach, C.L.N.; Cadrin-Tourigny, J.; Orgeron, G.; Tichnell, C.; Murray, B.; ... ; Riele, A.S.J.M. te (2022)

Article / Letter to editor

Aims: Arrhythmogenic right ventricular cardiomyopathy (ARVC) patients have an increased risk of ventricular arrhythmias (VA). Four implantable cardioverter-defibrillator (ICD) recommendation algorithms are available The International Task Force Consensus ('ITFC'), an ITFC modification by Orgeron et al. ('mITFC'), the AHA/HRS/ACC guideline for VA management ('AHA'), and the HRS expert consensus statement ('HRS'). This study aims to validate and compare the performance of these algorithms in ARVC. Methods and results: We classified 617 definite ARVC patients (38.5 +/- 15.1 years, 52.4% male, 39.2% prior sustained VA) according to four algorithms. Clinical performance was evaluated by sensitivity, specificity, ROC-analysis, and decision curve analysis for any sustained VA and for fast VA (>250 b.p.m.). During 6.4 [2.8-11.5] years follow-up, 282 (45.7%) patients experienced any sustained VA, and 63 (10.2%) fast VA. For any sustained VA, ITFC and mITFC provide higher sensitivity than AHA and HRS (94.0-97.8% vs. 76.7-83.5%), but lower specificity (15.9-32.0% vs. 42.7%-60.1%). Similarly, for fast VA, ITFC and mITFC provide higher sensitivity than AHA and HRS (95.2-97.1% vs. 76.7-78.4%) but lower specificity (42.7-43.1 vs. 76.7-78.4%). Decision curve analysis showed ITFC and mITFC to be superior for a 5-year sustained VA risk ICD indication threshold between 5-25% or 2-9% for fast VA. Conclusion: The ITFC and mITFC provide the highest protection rates, whereas AHA and HRS decrease unnecessary ICD placements. ITFC or mITFC should be used if we consider the 5-year threshold for ICD indication to lie within 5-25% for sustained VA or 2-9% for fast VA. These data will inform decision-making for ICD placement in ARVC.

• Arrhythmogenic right ventricular cardiomyopathy
• Prognosis
• Risk stratification
• Implantable cardioverter-defibrillator
• Ventricular arrhythmias

• All authors: Bosman, L.P.; Gerlach, C.L.N.; Cadrin-Tourigny, J.; Orgeron, G.; Tichnell, C.; Murray, B.; Bourfiss, M.; Heijden, J.F. van der; Yap, S.C.; Zeppenfeld, K.; Berg, M.P. van den; Wilde, A.A.M.; Asselbergs, F.W.; Tandri, H.; Calkins, H.; Tintelen, J.P. van; James, C.A.; Riele, A.S.J.M. te
• Date: 2022-02-02
• Journal: EP Europace
• Volume: 24
• Issue: 2
• Pages: 296 - 305
• DOI: doi:10.1093/europace/euab162