Long-term prognosis of idiopathic ventricular fibrillation: An eighteen-year experience from a tertiary center

Area of Science:

• Cardiology
• Genetics
• Electrophysiology

Background:

• Idiopathic ventricular fibrillation (IVF) affects sudden cardiac arrest (SCA) survivors without clear causes.
• Limited guidance exists for IVF patient diagnosis and management.
• Assessing clinical outcomes in aborted SCA attributed to IVF is crucial.

Purpose of the Study:

• To evaluate the clinical outcomes of survivors of aborted sudden cardiac arrest (SCA) attributed to idiopathic ventricular fibrillation (IVF).
• To determine the diagnostic yield of genetic testing in identifying underlying causes of IVF.
• To assess the long-term prognosis and recurrence rates in this patient cohort.

Main Methods:

• Retrospective collection of clinical data from SCA survivors who received an implantable cardioverter-defibrillator (ICD) between 2005 and 2023.
• Comprehensive diagnostic evaluation to exclude structural and coronary heart disease.
• Analysis of outcomes including mortality, arrhythmic recurrence, and ICD therapies, with a focus on the impact of genetic testing.

Main Results:

• 38 patients (mean age 44±14 years) were followed for a median of 8.7 years.
• Underlying diagnoses were found in 34.2% of patients.
• Genetic testing identified causes in 57.1% of tested individuals, significantly higher than in non-tested patients (26.3%, p=0.035).
• Mortality was 10.5% (non-arrhythmic), and 36.8% received appropriate ICD therapies.

Conclusions:

• Etiological diagnosis and recurrence prediction in idiopathic ventricular fibrillation (IVF) remain challenging.
• Genetic testing substantially increases the diagnostic yield for underlying causes in IVF patients.
• The study confirms significant arrhythmic recurrence risk, emphasizing the critical role of ICDs in managing these survivors.