Key result
A positive programmed ventricular stimulation test was associated with a higher rate of major arrhythmic events compared to a negative test (29% vs 1.5%; P<0.001).
Why the study?
A substantial proportion of sudden cardiac deaths occur in patients with NICM and LVEF ≥40% who do not meet current ICD implantation criteria, necessitating improved risk stratification methods.
Does programmed ventricular stimulation predict major arrhythmic events in patients with nonischemic cardiomyopathy, myocardial scar, and LVEF ≥40%?
Cohort (n=182)
No
Does programmed ventricular stimulation predict major arrhythmic events in patients with nonischemic cardiomyopathy, myocardial scar, and LVEF ≥40%?
Absolute Event Rate: 29% vs 1.5%
p-value: p=< 0.001
Programmed ventricular stimulation effectively stratifies arrhythmic risk in patients with nonischemic cardiomyopathy and preserved or mildly reduced LVEF, with a high negative predictive value of 98.5%.
May support risk stratification in nonischemic cardiomyopathy with LVEF ≥40%; hypothesis-generating and requires prospective validation before guiding ICD decisions.
BACKGROUND: A substantial proportion of sudden cardiac deaths occur in patients with nonischemic cardiomyopathy (NICM) and left ventricular ejection fraction (LVEF) ≥40% who do not meet current criteria for implantable cardioverter-defibrillator (ICD) implantation. OBJECTIVES: This study sought to evaluate programmed ventricular stimulation (PVS) for arrhythmic risk stratification in patients with NICM, cardiac magnetic resonance-confirmed myocardial scar, and LVEF ≥40%. METHODS: Consecutive patients with NICM, LVEF ≥40%, late gadolinium enhancement on cardiac magnetic resonance, and frequent premature ventricular complexes (PVCs; >5%) or nonsustained ventricular tachycardia who underwent PVS at a tertiary center (2014-2025) were included. The primary outcome was a major arrhythmic event (MAE): sustained ventricular tachycardia/fibrillation, appropriate ICD therapy, or sudden cardiac death. RESULTS: Among 182 patients (median aged 62 years; 33% women), PVS was positive in 45 (25%). Over a median 3.5-year follow-up, MAE occurred in 13 of 45 PVS-positive (29%) vs 2 of 137 PVS-negative patients (1.5%; P < 0.001), yielding a negative predictive value of 98.5%. Additional MAE predictors included multifocal PVCs/nonsustained ventricular tachycardia (HR: 6.6; 95% CI: 1.8-24.4), family history of sudden cardiac death (HR: 16.7; 95% CI: 4.5-62.3), QRS ≥100 milliseconds (HR: 5.2; 95% CI: 1.4-19.2), and LVEF ≤50% (HR: 4.4; 95% CI: 1.4-13.4; all P < 0.05). A noninvasive risk score incorporating these 4 variables yielded an optimism-corrected C-statistic of 0.892 (95% CI: 0.805-0.957). CONCLUSIONS: PVS represents a useful tool for risk stratification of arrhythmic events in patients with NICM, myocardial scar and preserved or mildly reduced LVEF, identifying those who may benefit from primary prevention ICD implant.
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Gardziejczyk et al. (2026) conducted a cohort in Nonischemic cardiomyopathy with preserved or mildly reduced LVEF (n=182). Programmed ventricular stimulation (PVS) positive vs. PVS negative was evaluated on Major arrhythmic event (MAE): sustained ventricular tachycardia/fibrillation, appropriate ICD therapy, or sudden cardiac death (p=< 0.001). A positive programmed ventricular stimulation test was associated with a higher rate of major arrhythmic events compared to a negative test (29% vs 1.5%; P<0.001).
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