Key result
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).
Why the study?
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?
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?
Effect estimate: HR 1.75
p-value: p=0.003
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.
Frequent VPBs on brief Holter may aid risk stratification in post-MI LV dysfunction; leaves open prospective validation before guiding ICD decisions.
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 < 0.05); but it was not a significant predictor of mortality after adjustment for clinical covariates (age, ejection fraction, beta-blocker use, and BUN levels). There was no association between HRT parameters and arrhythmic events in ICD patients. Conventionally treated patients who died and ICD patients who had appropriate ICD therapy had significantly more frequent VPBs than those without such adverse events. After adjustment for clinical covariates, frequent VPBs>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.
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Berkowitsch et al. (2004) conducted an 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).
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