Patients with syncope and inducible ventricular arrhythmia undergoing defibrillator implantation had a significantly lower 1-year mortality (5.1% vs. 8.9%, HR 0.56) compared to patients with a secondary preventive indication.
Observational (n=2,170)
Yes
Does defibrillator implantation in patients with syncope and inducible ventricular arrhythmia yield different clinical outcomes compared to secondary preventive indications?
Patients with syncope and inducible ventricular arrhythmia undergoing defibrillator implantation have lower 1-year mortality and MACCE compared to those with a secondary preventive indication.
Effect estimate: HR 0.56 (95% CI 0.33-0.97)
Absolute Event Rate: 5.1% vs 8.9%
p-value: p=0.036
History of syncope is an independent predictor for sudden cardiac death. Programmed stimulation may be considered for risk stratification, but data remain sparse among different populations. Here, we analyzed the prognostic value of inducible ventricular arrhythmia (VA) regarding clinical outcome in patients with syncope undergoing defibrillator implantation. Among 4196 patients enrolled in the prospective, multi-center German Device Registry, patients with syncope and inducible VA (n = 285, 6.8%) vs. those with a secondary preventive indication (n = 1885, 45.2%), defined as previously documented sustained ventricular tachycardia or ventricular fibrillation, serving as a control group were studied regarding demographics, device implantation and post-procedural adverse events. Patients with syncope and inducible VA (64.9 ± 14.4 years, 81.1% male) presented less frequently with congestive heart failure (15.1% vs. 29.1%; p < 0.001) and any structural heart disease (84.9% vs. 89.3%; p = 0.030) than patients with a secondary preventive indication (65.0 ± 13.8 years, 81.0% male). Whereas dilated cardiomyopathy (16.8% vs. 23.8%; p = 0.009) was less common, hypertrophic cardiomyopathy (5.6% vs. 2.8%; p = 0.010) and Brugada syndrome (2.1% vs. 0.3%; p < 0.001) were present more often. During 1-year-follow-up, mortality (5.1% vs. 8.9%; p = 0.036) and the rate of major adverse cardiac or cerebrovascular events (5.8% vs. 10.0%; p = 0.027) were lower in patients with syncope and inducible VA. Among patients with inducible VA, post-procedural adverse events including rehospitalization (27.6% vs. 21.7%; p = 0.37) did not differ between those with vs. without syncope. Taken together, patients with syncope and inducible VA have better clinical outcomes than patients with a secondary preventive defibrillator indication, but comparable outcomes to patients without syncope, which underlines the relevance of VA inducibility, potentially irrespective of a syncope.
Kahle et al. (Thu,) conducted a observational in Syncope and inducible ventricular arrhythmia (n=2,170). ICD implantation for syncope and inducible ventricular arrhythmia vs. ICD implantation for secondary preventive indication was evaluated on 1-year mortality (HR 0.56, 95% CI 0.33-0.97, p=0.036). Patients with syncope and inducible ventricular arrhythmia undergoing defibrillator implantation had a significantly lower 1-year mortality (5.1% vs. 8.9%, HR 0.56) compared to patients with a secondary preventive indication.