Key result
Positive PVS linked to ~7-fold higher arrhythmic death and ICD-treated VF in ischaemic cardiomyopathy.
Why the study?
The role of programmed ventricular stimulation (PVS) in risk stratification of patients with ischaemic cardiomyopathy and reduced LVEF for implantable cardioverter-defibrillator candidacy was assessed.
Does programmed ventricular stimulation predict arrhythmic death and VF requiring ICD shock in patients with ischaemic cardiomyopathy?
Cohort (n=106)
Does programmed ventricular stimulation predict arrhythmic death and VF requiring ICD shock in patients with ischaemic cardiomyopathy?
Hazard Ratio: 7.32 (95% CI 1.6–32)
Programmed ventricular stimulation remains a strong predictor of arrhythmic risk in ischaemic cardiomyopathy, with a negative test identifying patients at very low risk.
Negative PVS identifies low arrhythmic risk in ICM; leaves open its additive value for ICD selection beyond LVEF.
AIMS: The present study assessed the role of programmed ventricular stimulation (PVS) in risk stratification of patients with ischaemic cardiomyopathy (ICM), candidates for implantable cardioverter-defibrillator (ICD). METHODS AND RESULTS: Consecutive patients with ICM and LVEF < or = 40% (n = 106, age 61 +/- 7 years, LVEF 27 +/- 7%) underwent PVS. This was considered positive in case of inducibility of monomorphic ventricular tachycardia (VT) with < or =3 extrastimuli; polymorphic VT, ventricular fibrillation (VF), and fast monomorphic VT (CL < or = 230 ms) with < or =2 extrastimuli. Primary end-point was the combination of arrhythmic death and VF requiring ICD shock. Forty-nine patients (46%) were inducible at PVS; 74 (70%) were implanted with ICD. During a 24-month follow-up, the primary end-point occurred more frequently in positive PVS patients among the overall population, among patients with LVEF < or = 30% (n = 80) and among patients with an ICD. The negative predictive value of PVS was 96% in each group. In the overall population, both PVS (HR 7.32, 95% CI 1.6-32) and LVEF (HR 4.59, 95% CI 1.6-13) predicted the primary end-point. CONCLUSION: PVS may still have a role in predicting the arrhythmic risk in patients with ICM. A negative PVS identifies a subgroup with a very low risk of arrhythmic events even in patients with LVEF < or = 30%.
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Ferrari et al. (2007) conducted a cohort in ischaemic cardiomyopathy (n=106). Programmed ventricular stimulation (PVS) vs. Negative PVS was evaluated on Combination of arrhythmic death and VF requiring ICD shock (HR 7.32, 95% CI 1.6-32). Positive programmed ventricular stimulation predicted the combination of arrhythmic death and VF requiring ICD shock in patients with ischaemic cardiomyopathy (HR 7.32; 95% CI 1.6-32).
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