Atrial tachyarrhythmias and heart failure events in patients with arrhythmogenic right ventricular cardiomyopathy

BACKGROUND: Atrial tachyarrhythmias (ATAs) are associated with an increased risk of incident heart failure (HF). The aim of this study was to evaluate the incidence of ATAs and time of ATA development during disease progression as well as the influence of ATAs on HF-related events in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). METHODS: We retrospectively studied 90 ARVC patients who met the definitive diagnosis of the 2010 Task Force Criteria and were diagnosed with ARVC at our institutions between 1974 and 2012. The main outcomes were death due to HF and hospitalization due to worsening HF. RESULTS: Eleven patients had a history of ATAs at the time of ARVC diagnosis. Of 79 patients without a prediagnosis history of ATAs, 21 (27%) newly experienced ATAs during a median follow-up period of 11.4 (range, 0.1–29.6) years. Among them, 15 patients experienced their first hospitalization due to worsening HF a median of 1.7 (range, 0.0–9.8) years after the occurrence of ATAs. Patients with ATAs were more likely to experience death due to HF and hospitalization due to worsening HF than patients without ATAs (odds ratio 19.2, 95% confidence interval 2.0–92.3, P < 0.01 and odds ratio 29.7, 95% confidence interval 8.4–104.8, P < 0.01, respectively). Multivariable analysis revealed that ATAs were associated with an increased risk of hospitalization due to worsening HF (hazard ratio 15.55, 95% confidence interval 4.82–50.17, P < 0.01). CONCLUSIONS: Our study suggests that the occurrence of ATAs is associated with an increased risk of HF-related events and worsens the prognosis of ARVC patients.