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Previous Volume 358:2688-2697 June 19, 2008 Number 25 Next

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ABSTRACT

Background Sudden death can occur as a consequence of cardiac-conduction abnormalities in the neuromuscular disease myotonic dystrophy type 1. The determinants of the risk of sudden death remain imprecise.

Methods We assessed whether the electrocardiogram (ECG) was useful in predicting sudden death in 406 adult patients with genetically confirmed myotonic dystrophy type 1. A patient was characterized as having a severe abnormality if the ECG had at least one of the following features: rhythm other than sinus, PR interval of 240 msec or more, QRS duration of 120 msec or more, or second-degree or third-degree atrioventricular block.

Results Patients with severe abnormalities according to the entry ECG were older than patients without severe abnormalities, had more severe skeletal-muscle impairment, and were more likely to have heart failure, left ventricular systolic dysfunction, or atrial tachyarrhythmia. Such patients were more likely to receive a pacemaker or an implantable cardioverter–defibrillator during the follow-up period. During a mean follow-up period of 5.7 years, 81 patients died; there were 27 sudden deaths, 32 deaths from progressive neuromuscular respiratory failure, 5 nonsudden deaths from cardiac causes, and 17 deaths from other causes. Among the 17 patients who died suddenly in whom postcollapse rhythm was evaluated, a ventricular tachyarrhythmia was observed in 9. A severe ECG abnormality (relative risk, 3.30; 95% confidence interval [CI], 1.24 to 8.78) and a clinical diagnosis of atrial tachyarrhythmia (relative risk, 5.18; 95% CI, 2.28 to 11.77) were independent risk factors for sudden death.

Conclusions Patients with adult myotonic dystrophy type 1 are at high risk for arrhythmias and sudden death. A severe abnormality on the ECG and a diagnosis of an atrial tachyarrhythmia predict sudden death. (ClinicalTrials.gov number, NCT00622453 [ClinicalTrials.gov] .)

Source Information

From the Department of Medicine, Krannert Institute of Cardiology (W.J.G., M.R.G., R.F.O., D.B., G.V.N., M.M.M., D.P.Z.), the Division of Biostatistics (C.S.), and the Department of Neurology (J.C.K., R.M.P.), Indiana University, Indianapolis; the Department of Neurology, Pennsylvania State University, Hershey (Z.S.); the Department of Neurology, University of Rochester, Rochester, NY (E.C.); and the Department of Neurology, State University of New York at Stony Brook, Stony Brook (R.P.).

Address reprint requests to Dr. Groh at the Krannert Institute of Cardiology, Indiana University, 1800 N. Capitol, Rm. E406, Indianapolis, IN 46202, or at wgroh{at}iupui.edu.

Full Text of this Article

Related Letters:

Sudden Death in Myotonic Dystrophy
Russo A. D., Pace M., Bellocci F., Hermans M. C.E., Faber C. G., Pinto Y. M., Vrtovec B., Haddad F., Sovari A. A., Dudley S. C. Jr., Groh W. J., Bhakta D., Pascuzzi R. M.
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N Engl J Med 2008; 359:1626-1629, Oct 9, 2008. Correspondence

This article has been cited by other articles:

• Russo, A. D., Pace, M., Bellocci, F., Hermans, M. C.E., Faber, C. G., Pinto, Y. M., Vrtovec, B., Haddad, F., Sovari, A. A., Dudley, S. C. Jr., Groh, W. J., Bhakta, D., Pascuzzi, R. M. (2008). Sudden death in myotonic dystrophy.. NEJM 359: 1626-1628 [Full Text]  
• (2008). Determinants of Risk for Sudden Death in Myotonic Dystrophy. Journal Watch Cardiology 2008: 3-3 [Full Text]