Key result
Sustained ventricular arrhythmia induction during PVS is linked to higher all-cause mortality in unexplained syncope.
Why the study?
Programmed ventricular stimulation during electrophysiological study is accepted for sudden cardiac death risk stratification, but the prognosis of ventricular arrhythmia induction in patients with syncope of undetermined origin required evaluation.
Does the induction of ventricular arrhythmias during programmed ventricular stimulation predict mortality and appropriate ICD therapies in adult patients with syncope of unexplained origin?
Cohort (n=575)
Does the induction of ventricular arrhythmias during programmed ventricular stimulation predict mortality and appropriate ICD therapies in adult patients with syncope of unexplained origin?
p-value: p=<.001
In patients with syncope of unexplained origin, the induction of sustained monomorphic ventricular arrhythmia during electrophysiological study is associated with higher all-cause mortality and appropriate ICD therapies.
Supports EPS induction as prognostic marker in unexplained syncope; leaves open whether it should guide ICD decisions without randomized confirmation.
Background Programmed ventricular stimulation (PVS) during electrophysiological study (EPS), is a globally accepted tool for risk stratification of sudden cardiac death (SCD) in some specific clinical situations. The aim of this study was to evaluate the prognosis of ventricular arrhythmia induction in a cohort of patients with syncope of undetermined origin (SUO). Methods This is a historical cohort study in a population of patients with SUO referred for EPS between the years 2008–2021. In this interval, 575 patients underwent the procedure. Results Patients with induced ventricular arrhythmias had a higher occurrence of structural heart disease (36.7% vs. 76.5%), ischemic heart disease (28.2 vs. 57.1%), heart failure (15.5% vs. 34.4%), and lower left ventricular ejection fraction (59.16% vs. 47.51%), when compared to the outcome with a negative study. PVS triggered ventricular arrhythmias in 98 patients, 62 monomorphic and 36 polymorphic. During a median follow‐up of 37.6 months, 100 deaths occurred. Only the induction of sustained ventricular arrhythmias showed a significant association with the primary outcome (all‐cause mortality) with a p value <.001. After the performance of EPS, 142 patients underwent cardioverter‐defibrillator (ICD) implantation. At study follow‐up, 30 patients had therapies by the device. Only the induction of sustained monomorphic ventricular arrhythmia showed statistically significant association with appropriate therapies by the device (p = .012). Conclusion In patients with SUO, the induction of sustained monomorphic ventricular arrhythmia after programmed ventricular pacing is related to a worse prognosis, with a higher incidence of mortality and appropriate therapies by the ICD.
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Finkler et al. (2023) conducted a cohort in Syncope of unexplained origin (n=575). Induction of sustained ventricular arrhythmias vs. Negative study (no induction of ventricular arrhythmias) was evaluated on All-cause mortality (p=<.001). Induction of sustained ventricular arrhythmias during programmed ventricular stimulation was significantly associated with all-cause mortality in patients with unexplained syncope (p<0.001).
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