When a patient is diagnosed with arrhythmogenic right ventricular cardiomyopathy (ARVD), first-degree relatives should undergo screening for ARVD. What is the best/recommended screening protocol for first-degree relatives? How often serial follow-up evaluation in individuals at risk of developing ARVD (first- degree relatives) should be done? As electrical abnormalities precede detectable structural changes in subjects at risk for ARVD, should screening with serial ECG and Holter be enough or you recommend also periodical imaging diagnostic (echo/CMR). Do you have different screening protocol for relatives with the presence of a pathogenic mutation (mutation carriers) or relatives of a mutation-negative proband.

What is your experience and how often do you use signal-averaged ECG as one of the criteria (Task Force criteria) for diagnosis of ARVD?