Nonsustained ventricular tachycardia on Holter ECG had a 9% positive predictive value and 95% negative predictive value for sudden death in a nontertiary hypertrophic cardiomyopathy cohort.
Cohort (n=178)
Does the presence of nonsustained ventricular tachycardia on ambulatory Holter ECG predict sudden death in patients with hypertrophic cardiomyopathy?
In a nontertiary HCM cohort, NSVT on Holter ECG is common but has a low positive predictive value (9%) and high negative predictive value (95%) for sudden death.
OBJECTIVES: The goal of this study was to assemble a profile and assess the significance of arrhythmias in a nontertiary-based hypertrophic cardiomyopathy (HCM) cohort. BACKGROUND: Hypertrophic cardiomyopathy is associated with arrhythmia-related consequences, particularly sudden death. Ventricular tachyarrhythmias on Holter electrocardiograms (ECG) have been reported as markers for sudden death in highly selected HCM populations. METHODS: We assessed the profile of ventricular and supraventricular ectopy and bradyarrhythmia on ambulatory 24-h Holter ECG and also related these findings to clinical outcome in 178 HCM patients. RESULTS: Of the 178 study patients, 157 (88%) had premature ventricular complexes (PVCs), including 21 (12%) with >/=500 PVCs, 74 (42%) had couplets, 67 (37%) had supraventricular tachycardia (SVT), and 56 (31%) had nonsustained ventricular tachycardia (NSVT). Mean number of PVCs was 330 +/- 763 (range 1 to 5,435) and increased with age (p < 0.01); NSVT was associated with greater left ventricular hypertrophy (p = 0.01) and severe symptoms (New York Heart Association functional classes III and IV) (p = 0.04); SVT occurred more commonly in patients with outflow obstruction (p = 0.02). Over a follow-up of 5.5 +/- 3.4 years, 11 (6%) patients died suddenly (annual mortality rate, 1.1%) including 5 patients with NSVT. For sudden death, NSVT on Holter ECG had negative and positive predictive values of 95% and 9%, and sensitivity and specificity of 45% and 69%, respectively. CONCLUSIONS: In this nontertiary-based HCM cohort, ventricular and supraventricular tachyarrhythmias were particularly frequent and demonstrated a broad spectrum on ambulatory (Holter) ECG. Paradoxically, despite such a highly arrhythmogenic substrate, sudden death events proved to be relatively uncommon. Ventricular tachyarrhythmias had a low positive and relatively high negative predictive value for sudden death in this HCM population.
Adabağ et al. (2005) conducted a cohort in Hypertrophic cardiomyopathy (n=178). Nonsustained ventricular tachycardia on ambulatory 24-h Holter ECG vs. Absence of nonsustained ventricular tachycardia was evaluated on Sudden death. Nonsustained ventricular tachycardia on Holter ECG had a 9% positive predictive value and 95% negative predictive value for sudden death in a nontertiary hypertrophic cardiomyopathy cohort.