Arrhythmogenic right ventricular dysplasia

Revision as of 00:43, 5 January 2016 by Kxl328 (talk | contribs) (→‎Sources)

Background

  • ARVD is a significant contributor to sudden cardiac death in young patients
  • More common in males and those of Mediterranean descent
  • 1:1000-10,000 in the US
  • Fibro-fatty replacement of myocardium

Clinical Features

  • Syncope
  • Family history of unexplained syncope or sudden death
  • Dysrhythmias refractory to anti-dysrhythmic meds

Diagnosis

  • Major and minor criteria rely on echo and cardiac MRI
    • Echo - hypokinetic and dilated RV, dilation of RVOT
    • Cardiac MRI - fibro-fatty change with RV myocardial thinning, RV aneurysms, RV dilatation
  • EKG changes and respective sensitivities
    • Epsilon wave, 30-50%
    • V1-V3 TWI (especially in pts > 14 yoa), 85%
    • V1-V3 QRS widening
    • Sudden VT episodes with a LBBB morphology

Management

  • Sotalol is the preferred anti-dysrhythmic
  • Manage heart failure in the usual manner

Disposition

  • Cardiology follow-up for further risk assessment and possible ICD placement or ablation

Sources

  • Anderson EL. Arrhythmogenic right ventricular dysplasia. Am Fam Physician. 2006 Apr 15;73(8):1391-8.
  • Perez Diez D, Brugada J. Diagnosis and Management of Arrhythmogenic Right Ventricular Dysplasia. E-Journal of the ESC Council for Cardiology Practice, European Society of Cardiology 2008.
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