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

13 Citations (Scopus)

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",
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publisher = "Oxford University Press",
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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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JO - Europace

JF - Europace

SN - 1099-5129

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