October 13, 2020EP EuropaceOpen Access

Prevalence and prognostic association of ventricular arrhythmia in non-ischaemic heart failure patients: results from the DANISH trial

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Why the study?

Improved risk stratification is needed to identify non-ischaemic heart failure patients who will benefit from primary prophylactic ICD implantation.

Does the presence of ventricular arrhythmia (NSVT or high PVC burden) identify non-ischaemic heart failure patients who benefit from primary prophylactic ICD implantation?

Structured PICO

Does the presence of ventricular arrhythmia (NSVT or high PVC burden) identify non-ischaemic heart failure patients who benefit from primary prophylactic ICD implantation?

Population

850 non-ischaemic systolic heart failure patients with left ventricle ≤35% and elevated N-terminal pro-brain natriuretic peptides

Intervention

Presence of non-sustained ventricular tachycardia (NSVT, defined as ≥3 consecutive PVCs with a rate of ≥100/min) or high burden PVCs (≥30 per hour) detected on 24-h Holter monitor

Comparator

Absence of NSVT or low burden PVCs (<30 per hour)

Outcome

Overall mortalityhard clinical

While ventricular arrhythmias (NSVT or high PVC burden) are associated with worse prognosis in non-ischemic heart failure, they do not identify patients who will specifically benefit from primary prophylactic ICD implantation.

Implication

NSVT or high PVC burden should not guide ICD selection in non-ischaemic HF; leaves open arrhythmia-based risk stratification.

Abstract

Aims Improved risk stratification to identify non-ischaemic heart failure patients who will benefit from primary prophylactic implantable cardioverter-defibrillator (ICD) is needed. We examined the potential of ventricular arrhythmia to identify patients who could benefit from an ICD. Methods and results A total of 850 non-ischaemic systolic heart failure patients with left ventricle ≤35% and elevated N-terminal pro-brain natriuretic peptides had a 24-h Holter monitor recording performed. We examined present non-sustained ventricular tachycardia (NSVT), defined as ≥3 consecutive premature ventricular contractions (PVCs) with a rate of ≥100/min, and number of PVCs per hour stratified into low (<30) and high burden (≥30) groups. Outcome measures were overall mortality, sudden cardiac death (SCD), and cardiovascular death (CVD). In total, 193 patients died, 49 from SCD and 125 from CVD. Non-sustained ventricular tachycardia (365 patients) was significantly associated with increased all-cause mortality [hazard ratio (HR) 1.47; 95% confidence interval (CI) 1.07–2.03; P = 0.02] and to CVD (HR 1.89; CI 1.25–2.87; P = 0.003). High burden PVC (352 patients) was associated with increased all-cause mortality (HR1.38; CI 1.00–1.90; P = 0.046) and with CVD (HR 1.78; CI 1.19–2.66; P = 0.005). There was no statistically significant association with SCD for neither NSVT nor PVC. In interaction analyses, neither NSVT (P = 0.56) nor high burden of PVC (P = 0.97) was associated with survival benefit from ICD implantation. Conclusion Ventricular arrhythmia in non-ischaemic heart failure patients was associated with a worse prognosis but could not be used to stratify patients to ICD implantation.