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Europace Advance Access published online on October 17, 2007
Europace, doi:10.1093/europace/eum230
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

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 and Maurizio Landolina

Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy

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.

Conclusion: PVS 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%.

Key Words: Cardiomyopathy, Electrophysiological study, Post-myocardial infarction, Risk stratification, Sudden death

* Corresponding author. Tel: +39 0382 503715; fax: +39 0382 503161. E-mail address: g.deferrari{at}smatteo.pv.it

Manuscript submitted 5 April 2007. Accepted after revision 24 September 2007.


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