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Predicting sustained ventricular arrhythmias in dilated cardiomyopathy: a meta-analysis and systematic review
Arjan Sammani1, Elham Kayvanpour2,3, Laurens P Bosman1
1Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Insights
Patients with dilated cardiomyopathy (DCM) face a high risk of sudden cardiac death. Key predictors for sustained ventricular arrhythmias include hypertension, prior arrhythmias, reduced ejection fraction, and late gadolinium enhancement, aiding in identifying candidates for cardioverter-defibrillator implantation.
Area of Science:
- Cardiology
- Electrophysiology
- Genetics
Background:
- Non-ischaemic dilated cardiomyopathy (DCM) increases the risk of sudden cardiac death.
- Identifying DCM patients who would benefit from implantable cardioverter-defibrillators (ICDs) is challenging.
- Predictors of sustained ventricular arrhythmias (SVAs) in DCM patients require further elucidation.
Purpose of the Study:
- To identify predictors of sustained ventricular arrhythmias (SVAs) in patients with dilated cardiomyopathy (DCM).
- To inform clinical decision-making regarding implantable cardioverter-defibrillator (ICD) implantation in DCM patients.
Main Methods:
- Systematic review and meta-analysis of studies on predictors of SVAs in DCM.
- Inclusion of 55 studies with 11,451 patients and a mean follow-up of 3.7 years.
- Exclusion of studies with high risk of bias; pooled analysis of uniformly defined predictors.
Main Results:
- The crude annual event rate for SVAs in DCM was 4.5%.
- Pooled analysis identified younger age, hypertension, prior SVAs, reduced left ventricular ejection fraction, left ventricular dilatation, and late gadolinium enhancement as significant predictors.
- Non-pooled analyses indicated prior non-sustained ventricular arrhythmias and specific genetic mutations (PLN, LMNA, FLNC) were also associated with arrhythmic outcomes.
Conclusions:
- The annual SVA event rate in DCM is approximately 4.5%.
- Hypertension, prior arrhythmias, reduced LVEF, LV dilatation, LGE, and specific genetic mutations are associated with increased risk.
- These findings can assist in selecting appropriate candidates for ICD implantation in DCM patients.
Aims:
Patients with non-ischaemic dilated cardiomyopathy (DCM) are at increased risk of sudden cardiac death. Identification of patients that may benefit from implantable cardioverter-defibrillator implantation remains challenging. In this study, we aimed to determine predictors of sustained ventricular arrhythmias in patients with DCM.
Methods And Results:
We searched MEDLINE/Embase for studies describing predictors of sustained ventricular arrhythmias in patients with DCM. Quality and bias were assessed using the Quality in Prognostic Studies tool, articles with high risk of bias in ≥2 areas were excluded. Unadjusted hazard ratios (HRs) of uniformly defined predictors were pooled, while all other predictors were evaluated in a systematic review. We included 55 studies (11 451 patients and 3.7 ± 2.3 years follow-up). Crude annual event rate was 4.5%. Younger age [HR 0.82; 95% CI (0.74-1.00)], hypertension [HR 1.95; 95% CI (1.26-3.00)], prior sustained ventricular arrhythmia [HR 4.15; 95% CI (1.32-13.02)], left ventricular ejection fraction on ultrasound [HR 1.45; 95% CI (1.19-1.78)], left ventricular dilatation (HR 1.10), and presence of late gadolinium enhancement [HR 5.55; 95% CI (4.02-7.67)] were associated with arrhythmic outcome in pooled analyses. Prior non-sustained ventricular arrhythmia and several genotypes [mutations in Phospholamban (PLN), Lamin A/C (LMNA), and Filamin-C (FLNC)] were associated with arrhythmic outcome in non-pooled analyses. Quality of evidence was moderate, and heterogeneity among studies was moderate to high.
Conclusions:
In patients with DCM, the annual event rate of sustained ventricular arrhythmias is approximately 4.5%. This risk is considerably higher in younger patients with hypertension, prior (non-)sustained ventricular arrhythmia, decreased left ventricular ejection fraction, left ventricular dilatation, late gadolinium enhancement, and genetic mutations (PLN, LMNA, and FLNC). These results may help determine appropriate candidates for implantable cardioverter-defibrillator implantation.
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