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Programmed ventricular stimulation for arrhythmia risk prediction in patients with idiopathic dilated cardiomyopathy
1Department of Cardiology, Hospital of the Philipps-University of Marburg, Germany.
Insights
Programmed ventricular stimulation (PVS) did not effectively predict arrhythmia risk in patients with idiopathic dilated cardiomyopathy (IDC) and nonsustained ventricular tachycardia (VT). The study lacked sufficient power to rule out moderate outcome differences between patients with and without inducible VT.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Research
Background:
- Nonsustained ventricular tachycardia (VT) in idiopathic dilated cardiomyopathy (IDC) is linked to increased sudden cardiac death risk.
- Effective risk stratification is crucial for managing patients with IDC and spontaneous nonsustained VT.
Purpose of the Study:
- To evaluate the utility of programmed ventricular stimulation (PVS) for predicting arrhythmia events in patients with IDC and nonsustained VT.
- To assess the correlation between inducible sustained ventricular arrhythmias during PVS and subsequent arrhythmic events.
Main Methods:
- 34 patients with IDC, reduced left ventricular ejection fraction (< or =35%), and spontaneous nonsustained VT underwent PVS.
- Patients were prospectively followed for 24+/-13 months for arrhythmic events, including sudden cardiac death and ICD shocks.
Main Results:
- Sustained ventricular arrhythmias were induced in 38% of patients (3% monomorphic VT, 29% polymorphic VT/ventricular fibrillation).
- No significant difference in arrhythmic events was observed between patients with inducible (31%) and non-inducible (24%) sustained ventricular arrhythmias during follow-up.
- Implantable cardioverter-defibrillators (ICDs) were implanted in all patients with inducible arrhythmias and 43% of those without.
Conclusions:
- Programmed ventricular stimulation (PVS) does not appear to be a helpful tool for arrhythmia risk stratification in this patient cohort.
- The study's limited sample size restricts definitive conclusions regarding PVS efficacy and the ability to exclude moderate outcome differences.
Objectives:
This study investigated the role of programmed ventricular stimulation (PVS) for arrhythmia risk prediction in patients with idiopathic dilated cardiomyopathy (IDC) and spontaneous nonsustained ventricular tachycardia (VT).
Background:
Nonsustained VT in patients with IDC has been associated with a high incidence of sudden cardiac death.
Methods:
Over the course of 4 years, 34 patients with IDC, a left ventricular (LV) ejection fraction < or = 35%, and spontaneous nonsustained VT underwent PVS. All patients were prospectively followed for 24+/-13 months.
Results:
Sustained ventricular arrhythmias were induced in 13 patients (38%). Sustained monomorphic VT was induced in three patients (9%), and polymorphic VT or ventricular fibrillation (VF) in another 10 patients (29%). No sustained ventricular arrhythmia could be induced in 21 study patients (62%). Prophylactic implantation of third-generation defibrillators (ICDs) with electrogram storage capability was performed in all 13 patients with inducible sustained VT or VF, and in nine of 21 patients (43%) without inducible sustained VT or VF. There were no significant differences between the additional use of amiodarone, d,I-sotalol, and beta-blocker therapy during follow-up in patients with and without inducible VT or VF. During 24+/-13 months of follow-up, arrhythmic events were observed in nine patients (26%) including sudden cardiac deaths in two patients and ICD shocks for rapid VT or VF in seven patients. Arrhythmic events during follow-up occurred in four of 13 patients with inducible ventricular arrhythmias compared with five of 21 patients without inducible ventricular arrhythmias at PVS (31% vs. 24%, p=NS).
Conclusion:
PVS does not appear to be helpful for arrhythmia risk stratification in patients with IDC, a left ventricular ejection fraction < or =35%, and spontaneous nonsustained VT. Due to the limited number of patients, however, the power of this study is too small to exclude moderately large differences in outcome between patients with IDC with and without inducible VT or VF.