Noninvasive Programmed Stimulation Predicts Arrhythmia in Ischemic Cardiomyopathy With ICDs for Primary Prevention

Implantable cardioverter-defibrillators (ICDs) are essential for preventing sudden cardiac death in patients with ischemic cardiomyopathy (ICM). Noninvasive programmed stimulation (NIPS) is a potential tool for predicting ventricle tachycardia (VT) or ventricle fibrillation (VF) and helps to select patients with higher arrhythmic risk. This study aimed to evaluate the predictive value of NIPS in identifying ICM patients at risk for VT/VF episodes and mortality after ICD implantation for primary prevention.

This prospective, single-center study included 50 patients with ICM who underwent ICD or CRT-D implantation for primary prevention. NIPS was performed between 1- and 3-months following implantation and patients were followed for VT/VF recurrence and mortality.

Positive NIPS was observed in 20% of patients. During a median follow-up of 5.67 years, VT/VF occurred in 16% of patients. Kaplan-Meier analysis demonstrated a significantly increased risk of VT/VF episodes in the positive NIPS group (log-rank test, p = 0.047), with a considerably shorter time to VT/VF incidence (0.58 vs. 4.75 years). NIPS was not positively associated with an increased mortality rate (p = 0.45). However, elevated levels of creatinine and NT-pro BNP were significantly associated with higher mortality.

NIPS positivity predicts an increased risk of VT/VF episodes, supporting its role in predicting arrhythmic episodes but not mortality after ICD implantation for primary prevention with ICM. Creatinine and NT-proBNP levels were significantly associated with patient survival.

This prospective study was not registered in a public clinical trials registry, as registration was not required at the time of study initiation.