Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Assitant Professor Cynthia James, John Hopkins School of Medicine
- Second opponent: Seksjonsoverlege Erik Øie, Diakonhjemmet Hospital
- Third member of the adjudication committee: Professor Kjetil Sunde, University of Oslo
Principal Supervisor
Summary
Cardiac ventricular arrhythmias of right ventricular origin are a quite common complaint in the general population. These arrhythmias can have a wide variety of explanations, from benign outflow tract arrhythmia with frequent premature ventricular contractions to rare and severe inheritable arrhythmogenic cardiomyopathy.
Patients with frequent premature ventricular contractions of right ventricular outflow tract origin may contract an ectopy-induced cardiomyopathy. The threshold ectopy burden associated with impaired left ventricular function was lower than previously assumed when accurate and sensitive echocardiographic tools were used. Patients with more than 8000 premature ventricular contractions per 24 hours may benefit from antiarrhythmic therapy.
Arrhythmogenic cardiomyopathy is an inheritable cardiomyopathy associated with high risk of life-threatening ventricular arrhythmia and heart failure. This disease is characterized by exercise intolerance, but nothing is known about the type of exercise associated with harm. The exercise intensity and exercise duration at the time of diagnosis in 173 patients with the disease were assessed. Higher exercise intensity was a strong and independent marker of adverse outcome, irrespective of longer exercise duration. During 4 years of follow-up in patients presenting without life-threatening events, high intensity exercise was a strong predictor of first life-threatening ventricular arrhythmias. Together with ECG-abnormalities and subtle left ventricular contraction abnormalities, information on exercise intensity at study entry yielded precise risk stratification that may be useful in the challenging selection of patients with arrhythmogenic cardiomyopathy who may benefit from a primary preventive implantable cardioverter-defibrillator.
These observations improve our knowledge of risk stratification and management of patients with right ventricular arrhythmias, but external validation in larger studies is prudent to infer clinical implications.
Additional information
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