Europace Advance Access originally published online on December 18, 2008
Europace 2009 11(3):289-296; doi:10.1093/europace/eun330
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Implantable Cardioverter-Defibrillators
Induction of ventricular fibrillation rather than ventricular tachycardia predicts tachyarrhythmia recurrences in patients with idiopathic dilated cardiomyopathy and implantable cardioverter defibrillator for secondary prophylaxis
1 Department of Cardiology, Charité—Universitätsmedizin Berlin, Campus Virchow-Klinikum, Medizinische Klinik mit Schwerpunkt Kardiologie, Augustenburger Platz 1, D-13553 Berlin, Germany; 2 Department of Cardiology and Angiology, University Hospital Muenster, Muenster, Germany; 3 Faculty of Clinical Medicine of the University of Heidelberg, 1st Department of Medicine-Cardiology, University Hospital Mannheim, Mannheim, Germany
Aims: We sought to investigate the association of inducibility of polymorphic ventricular tachycardia or ventricular fibrillation (PVT/VF) or sustained monomorphic ventricular tachycardia (SMVT) at standardized programmed ventricular stimulation (PVS) with the long-term likelihood of sudden death and/or fast VT in a large cohort of patients with idiopathic non-ischaemic dilated cardiomyopathy (DCM) and implantable cardioverter defibrillator (ICD) for secondary prophylaxis.
Methods and results: Between 1994 and 2007, 160 consecutive patients with DCM and spontaneous sustained VT/VF or cardiac arrest underwent PVS prior to ICD implantation. Outcome data, particularly probability of survival without (sudden) death or appropriate ICD therapies for fast VT, were assessed during long-term follow-up. PVT/VF was induced in 50 (31%) and SMVT in 30 (19%) patients. During a mean follow-up of 53 ± 15 months, we observed 19/50 (38%), 10/30 (33%), and 14/80 (18%) deaths in the PVT/VF, SMVT, and non-inducible group, respectively. These deaths were sudden in 7/50 (14%), 2/30 (7%), and 0/80 (0%) of patients, respectively. At least one fast VT was treated by the ICD in 26/50 (52%), 6/30 (20%), and 22/80 (28%) patients, respectively. PVT/VF but not SMVT-inducible patients had a significantly worse overall survival (log-rank P = 0.013), survival without sudden cardiac death (P < 0.01), or survival without fast VT (P < 0.01) according to Kaplan–Meier method than non-inducible patients. Additionally, survival free of fast VT was significantly worse in PVT/VF vs. SMVT-inducible patients (P < 0.01).
Conclusion: Inducibility of PVT/VF is a much stronger predictor of recurrences of fast VT as opposed to SMVT induction in DCM patients with ICD for secondary prevention.
Key Words: Idiopathic dilated cardiomyopathy, Programmed ventricular stimulation, Electrophysiologic study, Implantable cardioverter defibrillator, Ventricular fibrillation, Ventricular tachycardia
* Corresponding author. Tel: +49 30 450653697, Fax: +49 30 4507553697, Email: sascha.rolf{at}charite.de
Manuscript submitted 28 May 2008. Accepted after revision 7 November 2008.
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  C. Plummer Implantable cardioverter defibrillator therapy for non-ischaemic cardiomyopathy. What is the role of programmed electrical stimulation? Europace, March 1, 2009; 11(3): 273 - 275. [Full Text] [PDF]
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