The Role of Ventricular Arrhythmias Inducibility in Arrhythmic Risk Stratification in Arrhythmogenic Right Ventricular Cardiomyopathy: A Meta-Analysis of Observational Studies.

Background: The identification of arrhythmogenic right ventricular cardiomyopathy (ARVC) patients at risk for fatal arrhythmic events is of great importance in clinical practice. Conflicting data exist regarding the role of electrophysiological study (EPS) in this setting. We aimed to examine the association of EPS inducibility with future fatal arrhythmic events in ARVC patients and its role as a risk stratification tool in the setting of primary prevention of sudden cardiac death (SCD). Methods: This meta-analysis was prepared in adherence to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Results: Eleven studies provided data on the association between EPS inducibility and fatal arrhythmic events and were therefore included in the quantitative analysis. EPS inducibility was significantly associated with arrhythmic events (RR: 2.15, 95% CI [1.63-2.85], p < 0.001) in the analysis that included patients with or without prior arrhythmic events. By including only patients without prior arrhythmic events, EPS inducibility was also significantly associated with arrhythmic events (RR: 1.93, 95% CI [1.20-3.10], p = 0.007). Conclusions: EPS inducibility can be a valuable tool for arrhythmic risk stratification purposes in ARVC patients, especially as a component of multiparametric risk scores. More studies are needed to examine the role of multiparametric risk scores, including EPS inducibility, in identifying ARVC patients at risk for fatal arrhythmic events.