Abstract
Conventional implantable cardioverter defibrillator (ICD) implanters target the apex for the placement of the right ventricular (RV) ICD lead. Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a progressive disease where healthy myocardium is replaced by fibrofatty tissue in the triangle of dysplasia, a region that includes the apex of the RV. Conventional wisdom suggests that RV leads should avoid the triangle of dysplasia as fibrofatty tissue replacement may result in a decrease in R-wave sensing for the ICD, and the inability of the ICD to detect potentially lethal arrhythmias and subsequently deliver life-saving therapy. This study compared ARVC patients to patients with structurally normal hearts, comparing R-wave amplitude over long-term follow-up. A retrospective chart review was performed from four major inherited arrhythmia clinics across Canada. The R-wave of ARVC patients were compared to patients with structurally normal hearts (control), including Long QT Syndrome (LQTS) and Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT). R-wave values were compared between years 1 and 2 post-implantation, and years 5 and 6 post-implantation using mixed-effect models adjusted for age and sex. 77 ARVC (55% male, 43.7±15.0 years) patients were compared to 46 patients with structurally normal heart35% male, 41.6±13.6 years). Mixed-effects models were constructed in Figure 1 and compared between the ARVC group (Figure 1A) and the control group (Figure 1B). There was no difference in R-wave when comparing the ARVC group and the control group at years 1 and 2 post-implantation years (8.56±4.20 mV and 8.43±3.72 mV retrospectively), however the ARVC group showed significant deterioration in amplitude compared to the control group at years 5 and 6 (7.53±3.83 mV and 9.67±3.92 mV, p=0.02, Figure 1). There was no difference in impedance between the two groups over a similar follow-up time (p=0.82). Long-term follow-up of RV lead performance in ARVC patients shows a decline in R wave amplitude compared to controls. Implanters should target regions outside of the apex when implanting ICD RV leads in ARVC patients.
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