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Electrophysiological evaluation of sustained ventricular tachyarrhythmias in idiopathic dilated cardiomyopathy
P G Milner1, J P Dimarco, B B Lerman
1Department of Internal Medicine, University of Virginia Medical Center, Charlottesville 22908.
Insights
Electrophysiological stimulation (EPS) did not predict outcomes in idiopathic dilated cardiomyopathy (IDC) patients with ventricular arrhythmias. Arrhythmia recurrence and sudden death remained high regardless of inducibility or drug suppression during EPS.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Research
Background:
- Idiopathic dilated cardiomyopathy (IDC) is linked to high rates of ventricular tachyarrhythmias and sudden cardiac death.
- The utility of electrophysiological stimulation (EPS) in managing IDC patients remains unclear, unlike in ischemic heart disease.
Purpose of the Study:
- To determine the role and prognostic value of EPS in patients with symptomatic ventricular tachyarrhythmias and IDC.
- To assess the impact of inducible arrhythmias and drug suppression on clinical outcomes in this population.
Main Methods:
- Nineteen patients with IDC and symptomatic ventricular tachycardia (VT) or ventricular fibrillation (VF) underwent EPS.
- Inducibility of clinical arrhythmias and response to antiarrhythmic drugs were evaluated.
- Patients were followed for arrhythmia recurrence and mortality.
Main Results:
- Electrophysiological stimulation (EPS) induced ventricular tachyarrhythmias (VT/VF) in 68% of patients.
- Arrhythmias were suppressed by drugs in 69% of inducible cases.
- No significant difference in arrhythmia recurrence or mortality was observed between patients with inducible versus non-inducible arrhythmias.
- Suppression of arrhythmias during drug testing did not correlate with improved outcomes.
Conclusions:
- Electrophysiological stimulation (EPS) and drug suppression testing do not appear to predict clinical outcomes in patients with idiopathic dilated cardiomyopathy (IDC).
- Further research is needed to establish effective risk stratification and management strategies for ventricular arrhythmias in IDC.
Abstract:
Sustained ventricular tachyarrhythmias and sudden death are particularly prevalent in patients with idiopathic dilated cardiomyopathy (IDC). In contrast to patients with ischemic heart disease, the value of electrophysiological stimulation (EPS) in patients with IDC has not yet been established. To clarify the role of EPS in these patients, we studied 19 patients (58 +/- 11 years) with IDC who had symptomatic ventricular tachycardia (VT) or ventricular fibrillation (VF). The mean left ventricular ejection fraction was 26 +/- 9%. Ten patients had survived out-of-hospital cardiac arrest, eight had documented sustained monomorphic VT and one patient had non-sustained VT associated with syncope. Thirteen of the 19 patients (68%) had their clinical ventricular tachyarrhythmias induced at EPS (12 VT, 1 VF). In nine of 13 patients (69%), the arrhythmias were subsequently suppressed during serial electrophysiological drug testing. During 17 +/- 11 months of follow-up, 10/19 (53%) patients experienced recurrence of their arrhythmias and nine out of 19 (47%) patients died; six died suddenly and three secondary to heart failure. There was no difference in arrhythmia recurrence between patients with and without inducible ventricular tachyarrhythmias at initial study. Furthermore, suppression of arrhythmia during serial testing did not predict outcome; recurrences were observed in five out of nine patients whose arrhythmias were suppressed.(ABSTRACT TRUNCATED AT 250 WORDS)