Arrhythmias & electrophysiology
Diagnostic pitfalls in patients referred for arrhythmogenic right ventricular cardiomyopathy
Authors' conclusion
False suspicion or misdiagnosis was found in the majority of patients referred for ARVC, resulting in inappropriate ICD implantation or recommendation in 14.5% of these patients. Misdiagnosis or false suspicion was most commonly due to misinterpretation of cardiac magnetic resonance imaging.
Study context
- Population
- Patients referred to a centre with previously diagnosed or suspected arrhythmogenic right ventricular cardiomyopathy (ARVC), January 2011–September 2019
- Participants
- 726 patients
- Outcome
- ARVC ruled out
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
- ARVC ruled out
- 365 (50.3%)
- Presenting symptom in ruled-out patients: palpitations
- n = 139, 38.1%
- Presenting symptom in ruled-out patients: ventricular arrhythmias
- n = 62, 17.0%
- Presenting symptom in ruled-out patients: chest pain
- n = 53, 14.5%
- Final diagnosis: idiopathic PVC/VT/VF
- 46.6%
- Final diagnosis: absence of disease
- 19.2%
- Final diagnosis: noncardiac presyncope/syncope
- 17.5%
- Contributor to diagnostic error: CMR mistaken RV wall motion abnormalities
- 33.2%
- Contributor to diagnostic error: CMR nonspecific fat
- 12.1%
Observational data: associations, not effects.
Safety
Implantable cardioverter-defibrillators (ICDs) in ruled-out patients
- Had received ICDs based on outside evaluation
- 23.8%
- Device extraction recommended after reevaluation
- 9.0%
- Had received ICD recommendations, all reversed on reevaluation
- 5.5%
- Inappropriate ICD implantation or recommendation
- 14.5%
Original publication
Diagnostic pitfalls in patients referred for arrhythmogenic right ventricular cardiomyopathy. Heart Rhythm. Published 30 August 2023. doi:10.
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