Frequent ventricular premature beats (>3/10 min) predicted appropriate ICD therapy (HR 1.75; P=0.003) and trended toward increased mortality in conventionally treated patients (HR 1.63; P=0.070).
RCT (n=884)
Yes
Do heart rate turbulence parameters and frequency of ventricular premature beats on a 10-minute Holter recording predict mortality or appropriate ICD therapy in postinfarction patients with depressed left ventricular function?
Frequent ventricular premature beats (>3 per 10 minutes) on a brief Holter recording independently predict appropriate ICD therapy in post-MI patients with severe LV dysfunction, whereas heart rate turbulence does not.
Effect estimate: HR 1.75
p-value: p=0.003
BACKGROUND: We evaluated the usefulness of heart rate turbulence (HRT) parameters and frequency of ventricular premature beats (VPBs) for risk-stratifying postinfarction patients with depressed left ventricular function enrolled in Multicenter Automatic Defibrillator Trial II (MADIT II). METHODS: In 884 MADIT II patients, 10-minute Holter monitoring at enrollment was used to evaluate HRT parameters and frequency of VPBs. The primary endpoints were defined as all-cause mortality in patients randomized to conventional treatment and as appropriate therapy for ventricular tachycardia or fibrillation in patients randomized to implantable cardioverter defibrillator (ICD) therapy. RESULTS: The median turbulence slope was lower in patients who died in comparison to survivors in the conventional arm (2.3 vs 4.5 ms/RR; P 3/10 min were associated with death in the conventional arm (HR = 1.63; P = 0.070) and were predictive for appropriate ICD therapy in the ICD arm (HR = 1.75; P = 0.003). CONCLUSION: In postinfarction patients with severe left ventricular dysfunction, frequent VPBs are associated with increased risk of mortality and with appropriate ICD therapy. HRT obtained from 10-min Holter ECG showed a trend toward the association with mortality in univariate analysis but HRT parameters were not predictive of the outcome in multivariate analyses.
Berkowitsch et al. (Thu,) conducted a rct in Postinfarction with depressed left ventricular function (n=884). Frequent ventricular premature beats (>3/10 min) vs. Infrequent ventricular premature beats was evaluated on All-cause mortality (conventional arm) and appropriate therapy for ventricular tachycardia or fibrillation (ICD arm) (HR 1.75, p=0.003). Frequent ventricular premature beats (>3/10 min) predicted appropriate ICD therapy (HR 1.75; P=0.003) and trended toward increased mortality in conventionally treated patients (HR 1.63; P=0.070).