Key result
EPS-guided risk stratification identified heart failure patients at high risk for arrhythmic events, with a 48.8% incidence in those with NSVT and inducible VT/VF compared to lower risk groups.
Why the study?
Does EPS-guided risk stratification predict future arrhythmic events in patients with heart failure without prior sustained VT/VF?
Cohort (n=474)
No
Does EPS-guided risk stratification predict future arrhythmic events in patients with heart failure without prior sustained VT/VF?
Absolute Event Rate: 48.8% vs 7.1%
p-value: p=0.032
EPS-guided risk stratification, utilizing Holter ECG followed by EPS for those with nonsustained VT, effectively predicts future life-threatening arrhythmic events in heart failure patients.
May support EPS-guided stratification in HF with NSVT; leaves open whether it improves outcomes or warrants ICD use.
BACKGROUND: Ventricular tachyarrhythmia is one of the most important factors determining the prognosis of patients with heart failure and sudden death can be observed even during stable therapy controlling clinical heart failure. In this study, the usefulness of electrophysiologic study (EPS) for the prediction of a future arrhythmic event was evaluated in patients with heart failure. METHODS AND RESULTS: The patient population consisted of 474 patients with a history of clinical heart failure but without an episode of spontaneous sustained ventricular tachycardia or fibrillation (VT/VF). A Holter ECG was performed in all patients, and 177 of the 474 patients underwent EPS because of a recording of nonsustained VT (NSVT, > 5 beats). When sustained VT/VF was inducible in EPS, the patient was assigned to implantation of a defibrillation device. The patients were divided into 3 groups, ie, 1) no NSVT (n = 297), 2) NSVT + no inducible VT/VF (n = 134), and 3) NSVT + inducible VT/VF (n = 43), and were followed-up for > 12 months. All patients were followed-up under standard therapy for heart failure. There were no significant differences in basic clinical characteristics and therapies among the 3 groups. During the follow-up period of 32 +/- 18 months, 56/474 patients suffered a VT/VF episode, ie, 21/297 in no NSVT, 14/134 in NSVT + no inducible VT/VF, and 21/43 in NSVT + inducible VT/VF patients (P = 0.032). All patients were rescued from sudden death among patients with an implanted defibrillator, but 11 patients without a defibrillator died. CONCLUSION: In patients with heart failure, future arrhythmic events could be predicted by EPS and Holter ECG. EPS-guided risk stratification seems to be useful in managing patients with heart failure.
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Sasaki et al. (2007) conducted a cohort in Heart failure (n=474). Electrophysiologic study (EPS)-guided risk stratification vs. Patients without nonsustained VT (NSVT) or with NSVT but no inducible VT/VF was evaluated on Arrhythmic events (VT/VF episodes) (p=0.032). EPS-guided risk stratification identified heart failure patients at high risk for arrhythmic events, with a 48.8% incidence in those with NSVT and inducible VT/VF compared to lower risk groups.
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