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

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Implantable Defibrillators
Cardiomyopathies
Ventricular Tachycardia
Ventricular Fibrillation
Population
Shock

Keywords

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

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

Cite this

@article{1617989dc32945a6ae74844f744e0cb4,
title = "Predictive value of programmed ventricular stimulation in patients with ischaemic cardiomyopathy: Implications for the selection of candidates for an implantable defibrillator",
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{\%}.",
keywords = "Cardiomyopathy, Electrophysiological study, Post-myocardial infarction, Risk stratification, Sudden death",
author = "{De Ferrari}, {Gaetano M.} and Roberto Rordorf and Folco Frattini and Barbara Petracci and {De Filippo}, Paolo and Maurizio Landolina",
year = "2007",
month = "12",
doi = "10.1093/europace/eum230",
language = "English",
volume = "9",
pages = "1151--1157",
journal = "Europace",
issn = "1099-5129",
publisher = "Oxford University Press",
number = "12",

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TY - JOUR

T1 - Predictive value of programmed ventricular stimulation in patients with ischaemic cardiomyopathy

T2 - Implications for the selection of candidates for an implantable defibrillator

AU - De Ferrari, Gaetano M.

AU - Rordorf, Roberto

AU - Frattini, Folco

AU - Petracci, Barbara

AU - De Filippo, Paolo

AU - Landolina, Maurizio

PY - 2007/12

Y1 - 2007/12

N2 - 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%.

AB - 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%.

KW - Cardiomyopathy

KW - Electrophysiological study

KW - Post-myocardial infarction

KW - Risk stratification

KW - Sudden death

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U2 - 10.1093/europace/eum230

DO - 10.1093/europace/eum230

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VL - 9

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JO - Europace

JF - Europace

SN - 1099-5129

IS - 12

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