Impaired Sinus Rate Behaviour During Ventricular Arrhythmia Is Associated With Adverse Outcomes in ICD Recipients

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Cardiomyopathy with implantable cardioverter-defibrillator and spontaneous ventricular arrhythmias (n=84). Intervention: Sinus rate acceleration during ventricular arrhythmia vs. Absent sinus rate acceleration. Primary outcome: Composite of all-cause mortality, heart transplantation, or ventricular assist device implantation (Mort/HTx/VAD) (HR 0.33, 95% CI 0.12-0.94, p=0.038).

Q: What does this research mean for the field?

Impaired sinus rate behavior during ventricular arrhythmia is associated with adverse clinical outcomes in patients with implantable cardioverter-defibrillators. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Maarten Blondeel; Stien Goris; Eva Goethals; Margot Vermeiren; Sebastian Ingelaere; Gábor Vörös; Thomas Rosseel; Christophe Garweg; Peter Haemers; Joris Ector; Rik Willems; Tomas Robyns; Tom De Potter; Bert Vandenberk

doi:10.1093/europace/euag251

September 3, 2026EP EuropaceOpen Access

Impaired Sinus Rate Behaviour During Ventricular Arrhythmia Is Associated With Adverse Outcomes in ICD Recipients

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Key result

Sinus rate acceleration during ventricular arrhythmia is linked to ~67% lower mortality, HTx, or VAD.

HR 0.33
95% CI 0.12-0.94
P=0.038
n=84

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Why the study?

Whether sinus rate behaviour during spontaneous ventricular arrhythmias in ICD recipients carries prognostic implications beyond procedural settings was unknown.

Does sinus rate acceleration during spontaneous ventricular arrhythmia predict a lower risk of adverse outcomes in ICD recipients?

Key Points

To evaluate whether sinus rate behaviour during spontaneous ventricular arrhythmias treated by implantable cardioverter-defibrillators predicts clinical tolerance and long-term adverse outcomes.
Retrospective cohort study of adult patients with ischemic or non-ischemic cardiomyopathy receiving a first ICD between 1996 and 2022 from a single-centre registry (N=84 included after screening 1615 patients).
Atrial rhythm during the first qualifying spontaneous ventricular arrhythmia was categorized as sinus rate acceleration (increase ≥5 bpm), absent acceleration, or retrograde conduction.
The primary endpoint was a composite of all-cause mortality, heart transplantation, or ventricular assist device implantation (Mort/HTx/VAD) evaluated over a median follow-up of 3.1 years.
Sinus rate acceleration occurred in 40% (34/84), absent acceleration in 36% (30/84), and retrograde conduction in 24% (20/84) of patients.
Compared with absent acceleration, sinus rate acceleration was independently associated with a lower risk of Mort/HTx/VAD (adjusted HR 0.33, 95% CI 0.12–0.94; P = 0.038).
Among 71 patients with ventricular tachycardia, absence of sinus rate acceleration independently increased the odds of (pre)syncope compared to sinus rate acceleration (adjusted OR 7.09, 95% CI 1.58–31.77; P = 0.011).

Study Design

Type

Cohort (n=84)

Multicenter

No

Structured PICO

Does sinus rate acceleration during spontaneous ventricular arrhythmia predict a lower risk of adverse outcomes in ICD recipients?

P

Population

84 adult ICD recipients with ischaemic or non-ischaemic cardiomyopathy and spontaneous ventricular arrhythmias, followed for a median of 3.1 years.

E

Exposure

Sinus rate acceleration (defined as an increase ≥5 bpm during ventricular arrhythmia compared with pre-VA baseline)

C

Comparator

Absence of sinus rate acceleration (or retrograde conduction)

O

Outcome

Composite of all-cause mortality, heart transplantation, or ventricular assist device implantation (Mort/HTx/VAD)composite

Main Result

Hazard Ratio: 0.33 (95% CI 0.12–0.94)

p-value: p=0.038

In ICD recipients, sinus rate acceleration during spontaneous ventricular arrhythmias is associated with a significantly lower risk of mortality or need for advanced heart failure therapies.

Limitations

Retrospective design and modest sample size
Restricted number of covariates that could be included in the multivariable model
Only the first interpretable ventricular arrhythmia episode per patient was analysed
Residual confounding cannot be excluded
Analysis was limited to the short ICD electrogram storage window
retrospective design
modest sample size restricting the number of covariates in the multivariable model
only the first interpretable VA episode per patient was analysed
residual confounding cannot be excluded
analysis limited to the ICD electrogram storage window

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Implication

May identify lower-risk ICD recipients during ventricular arrhythmia; hypothesis-generating for tolerance markers, needs prospective validation.

Abstract

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Cite This Study

Blondeel et al. (2026) conducted a cohort in Cardiomyopathy with implantable cardioverter-defibrillator and spontaneous ventricular arrhythmias (n=84). Sinus rate acceleration during ventricular arrhythmia vs. Absent sinus rate acceleration was evaluated on Composite of all-cause mortality, heart transplantation, or ventricular assist device implantation (Mort/HTx/VAD) (HR 0.33, 95% CI 0.12-0.94, p=0.038). Sinus rate acceleration during spontaneous ventricular arrhythmia was independently associated with a lower risk of mortality, heart transplantation, or ventricular assist device implantation.

synapsesocial.com/papers/6a9bd4126b95aff0620eb708 https://doi.org/10.1093/europace/euag251

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Impaired Sinus Rate Behaviour During Ventricular Arrhythmia Is Associated With Adverse Outcomes in ICD Recipients

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Impaired Sinus Rate Behaviour During Ventricular Arrhythmia Is Associated With Adverse Outcomes in ICD Recipients

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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