Wisdom before knowledge--appraisal of the scientific evidence used to develop guidelines for the diagnosis of arrhythmogenic right ventricular dysplasia

Background Guidelines are an important vehicle in the era of evidence-based medicine and diagnosis. They represent a culmination of expert opinions and the best available evidence. There can be a tendency for practitioners to view and apply guidelines as the absolute truth. However, it is important to remember that guidelines are only as robust as the strength of the studies that are used in their development. Arrhythmogenic right ventricular dysplasia (ARVD) is a relatively rare disease that primarily affects the right ventricle and can be potentially fatal if left untreated. Cardiac MRI (CMR) plays a supportive role in the diagnosis. A task force was established in 1994 and another convened in 2009, in order to develop guidelines for the diagnosis of ARVD. The aim of this exhibit is to critically appraise the studies that were used to classify the findings on CMR into major and minor criteria for the diagnosis of ARVD. The studies will be critiqued particularly for statistical biases and the potential for overdiagnosis.