Arrhythmogenic Right Ventricular Dysplasia - Management

Management

The goal of management of ARVD is to decrease the incidence of sudden cardiac death. This raises a clinical dilemma: How to prophylactically treat the asymptomatic patient who was diagnosed during family screening.

A certain subgroup of individuals with ARVD are considered at high risk for sudden cardiac death. Characteristics associated with high risk of sudden cardiac death include:

• Young age
• Competitive sports activity
• Malignant familial history
• Extensive RV disease with decreased right ventricular ejection fraction.
• Left ventricular involvement
• Syncope
• Episode of ventricular arrhythmia

Management options include pharmacological, surgical, catheter ablation, and placement of an implantable cardioverter-defibrillator.

Prior to the decision of the treatment option, programmed electrical stimulation in the electrophysiology laboratory may be performed for additional prognostic information. Goals of programmed stimulation include:

• Assessment of the disease's arrhythmogenic potential
• Evaluate the hemodynamic consequences of sustained VT
• Determine whether the VT can be interrupted via antitachycardia pacing.

Regardless of the management option chosen, the individual is typically suggested to undergo lifestyle modification, including avoidance of strenuous exercise, cardiac stimulants (i.e.: caffeine, nicotine, pseudoephedrine) and alcohol. If the individual wishes to begin an exercise regimen, an exercise stress test may have added benefit.