Predictive value of programmed ventricular stimulation in patients with ischaemic cardiomyopathy: Implications for the selection of candidates for an implantable defibrillator

Gaetano M. De Ferrari, Roberto Rordorf, Folco Frattini, Barbara Petracci, Paolo De Filippo, Maurizio Landolina

Research output: Contribution to journalArticle

Abstract

Aims: The present study assessed the role of programmed ventricular stimulation (PVS) in risk stratification of patients with ischaemic cardiomyopathy (ICM), candidates for implantable cardioverter-defibrillator (ICD). Methods and results: Consecutive patients with ICM and LVEF ≤ 40% (n = 106, age 61 ± 7 years, LVEF 27 ± 7%) underwent PVS. This was considered positive in case of inducibility of monomorphic ventricular tachycardia (VT) with ≤3 extrastimuli; polymorphic VT, ventricular fibrillation (VF), and fast monomorphic VT (CL ≤ 230 ms) with ≤2 extrastimuli. Primary end-point was the combination of arrhythmic death and VF requiring ICD shock. Forty-nine patients (46%) were inducible at PVS; 74 (70%) were implanted with ICD. During a 24-month follow-up, the primary end-point occurred more frequently in positive PVS patients among the overall population, among patients with LVEF ≤ 30% (n = 80) and among patients with an ICD. The negative predictive value of PVS was 96% in each group. In the overall population, both PVS (HR 7.32, 95% CI 1.6-32) and LVEF (HR 4.59, 95% CI 1.6-13) predicted the primary end-point.ConclusionPVS may still have a role in predicting the arrhythmic risk in patients with ICM. A negative PVS identifies a subgroup with a very low risk of arrhythmic events even in patients with LVEF ≤ 30%.

Original languageEnglish
Pages (from-to)1151-1157
Number of pages7
JournalEuropace
Volume9
Issue number12
DOIs
Publication statusPublished - Dec 2007

Keywords

  • Cardiomyopathy
  • Electrophysiological study
  • Post-myocardial infarction
  • Risk stratification
  • Sudden death

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

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