The role of programmed ventricular stimulation (PVS) in arrhythmic risk stratification is unclear in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D).

To determine clinical factors associated with inducibility of PVS and determine its pronostic value in the overall population and in three risk groups.

Between 2000 and 2010, 150 consecutive patients systematically benefited PVS at diagnosis. Predictors for PVS inducibility were studied. Risk factors for arrhythmic events were then determined by Cox regression in the entire population and in three risk groups.

VT inducibility was significantly higher for males (p=0.007), symptomatic patients (p<0.001) especially those with syncope (p=0.004), patients who had spontaneous ventricular tachycardia (VT) (p<0.001) and right (p<0.001) or left (p=0.03) ventricular dysfunction.

After a follow up of 48±32 months, we recorded 31 ventricular arrhythmias and 10 sudden cardiac deaths (SCD). Male gender, symptoms, syncope, sustained VT, right or left ventricular dysfunction and positive PVS were associated with ventricular arrhythmias. PVS had a 50% of sensibility on predicting SCD. The presence of a history of an aborted SCD, syncope or non tolerated VT identified high-risk subjects whereas asymptomatic patients represented a low risk group whatever PVS results were. Inducibility at PVS was associated with a higher rate of events in the intermediate risk group. A decision tree based on our analyses is shown on figure 1 above.

PVS inducibility is associated with the occurrence of sustained ventricular arrythmia but not with the occurrence of SCD. History of aborted SCD, syncope or non tolerated VT isolate a high risk group of patients whereas asymptomatic patients are at low risk. PVS seems to be interesting in the intermediate risk group for predicting ventricular arrhythmias.