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Arrhythmic risk stratification in ischemic, non-ischemic and hypertrophic cardiomyopathy: A two-step multifactorial,

Petros Arsenos1, Konstantinos A Gatzoulis2, Dimitrios Tsiachris3

  • 1First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens 11527, Attika, Greece.

World Journal of Cardiology
|April 18, 2022
PubMed

Insights

This study introduces a two-step arrhythmic risk stratification (ARS) method using non-invasive factors and programmed ventricular stimulation (PVS) to identify high-risk patients with cardiomyopathy who may benefit from defibrillators.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Sudden Cardiac Death

Background:

  • Arrhythmic sudden cardiac death (SCD) poses a significant risk in various cardiomyopathies, including ischemic (ICM), non-ischemic (NICM), and hypertrophic (HCM).
  • Current risk stratification methods have limitations in accurately identifying patients who would benefit from interventions like implantable cardioverter-defibrillators (ICDs).

Purpose of the Study:

  • To develop and present a novel two-step arrhythmic risk stratification (ARS) strategy.
  • To improve the selection of intermediate-risk patients for further invasive assessment.
  • To enhance the identification of high-risk patients with ICM, NICM, and HCM who would benefit from ICD implantation.

Main Methods:

  • A two-step ARS approach was developed.
  • Step 1 involves assessing seven non-invasive risk factors: late potentials, premature ventricular contractions, non-sustained ventricular tachycardia, heart rate turbulence, T wave alternans, heart rate variability, and prolonged QTc interval.
  • Step 2 utilizes programmed ventricular stimulation (PVS) for intermediate-risk patients, with suggested PVS use for specific HCM subgroups.

Main Results:

  • The proposed two-step ARS aims to refine the selection of patients for PVS.
  • PVS is intended to identify inducible high-risk ICM and NICM patients for ICD therapy.
  • For HCM, PVS incorporation aims to improve the sensitivity and specificity of risk assessment.

Conclusions:

  • The presented two-step ARS, combining non-invasive markers and PVS, offers a refined approach to stratify arrhythmic risk in cardiomyopathy.
  • This strategy may lead to more appropriate ICD implantation, particularly in ICM and NICM.
  • For HCM, tailored PVS application could optimize risk stratification and patient management.

Keywords:
Arrhythmias in cardiomyopathyArrhythmic sudden cardiac deathElectrophysiology studyNon-invasive risk factorsRisk stratificationTwo-step approach

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