Prognostic value of programmed ventricular stimulation for sudden death in selected high risk patients with structural heart disease and preserved systolic function

Gatzoulis, Konstantinos; Tsiachris, Dimitris; Αρσένος, Πέτρος; Archontakis, Stefanos; Dilaveris, Polychronis; Vouliotis, Apostolos Ilias; Sideris, Skevos; Skiadas, Ioannis; Kallikazaros, Ioannis; Stefanadis, Christodoulos

doi:10.1016/j.ijcard.2014.08.068

Cited by 40 publications

(31 citation statements)

References 9 publications

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“…W podgrupach w dużych badaniach uzyskano ograniczone dowody na to, że PVS jest pomocna w celu stratyfikacji ryzyka u pacjentów po zawale serca z pośrednimi wartościami LVEF lub z LVEF > 40% [280][281][282]. Kwestia ta …”

Section: Stratyfikacja Ryzykaunclassified

2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

Priori

Blomström‐Lundqvist²,

Mazzanti³

et al. 2015

Kardiol Pol

233

337

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Section: Stratyfikacja Ryzykaunclassified

2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

Priori

Blomström‐Lundqvist²,

Mazzanti³

et al. 2015

Kardiol Pol

233

337

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“…Furthermore, we show that PVS can be part of a clinical work-up based on individualized criterions to further characterize patients with an history of arrhythmias, even if the inducibility itself did not correlate with the occurrence of our defined study endpoints over a long-time period [23]. Our study may suggest the hypothesis that the absence of LGE identifies patients who have a lower risk for arrhythmogenic events irrespective of the indication for an ICD implantation.…”

Section: Discussionmentioning

confidence: 96%

“…Therefore, electrophysiological analysis employing PVS along with contrast-enhanced MRI may serve as helpful diagnostic tool in selected patients to assess their individual risk for sudden cardiac death [17, 21, 23]. Deeper evaluation is possible by electroanatomical mapping during eletrophysiological examinations, which may also help to characterize arrhythmogenic sites within the ventricle to enable an ablative therapy of ventricular arrhythmias if necessary during the course of the disease [5, 19, 20].…”

Section: Discussionmentioning

confidence: 99%

“…However, these reported collectives have only been characterized by their reduced LVEF and the exclusion of relevant coronary artery disease, while other non-invasive and invasive diagnostic tools, e.g. biopsy results, were not included [17, 21–23]. To our knowledge, the impact of endomyocardial biopsy (EMB) and its significance in the risk assessment of NIDCM patients has not been described yet.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Ventricular Inducibility with Late Gadolinium Enhancement and Myocardial Inflammation in Endomyocardial Biopsy in Patients with Dilated Cardiomyopathy

et al. 2016

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BackgroundRisk stratification of patients with non-ischemic dilated cardiomyopathy remains a matter of debate in the era of device implantation.ObjectiveWe investigated associations between histopathological findings, contrast-enhanced cardiac MRI and the inducibility of ventricular tachycardia (VT) or fibrillation (VF) in programmed ventricular stimulation.Methods56 patients with impaired left ventricular ejection fraction (LVEF≤50%, mean 36.6±10.5%) due to non-ischemic dilated cardiomyopathy underwent cardiac MRI, programmed ventricular stimulation, and endomyocardial biopsy and were retrospectively investigated. Inducibility was defined as sustained mono- or polymorphic VT or unstable VT/VF requiring cardioversion/defibrillation. Primary study endpoint was defined as the occurrence of hemodynamically relevant VT/VF and/or adequate ICD-therapy during follow-up.ResultsEndomyocardial biopsy detected cardiac fibrosis in 18 (32.1%) patients. Cardiac MRI revealed 35 (62.5%) patients with positive late gadolinium enhancement. VT/VF was induced in ten (17.9%) patients during programmed ventricular stimulation. Monomorphic VT was inducible in 70%, while 20% of patients showed polymorphic VT. One patient (10%) presented with VF. Inducibility correlated significantly with the presence of positive late gadolinium enhancement in cardiac MRI (p<0.01). We could not find a significant association between inducibility and the degree of cardiac inflammation and fibrosis in non-site directed routine right ventricular endomyocardial biopsy. During a mean follow-up of 2.6 years, nine (16.1%) patients reached the primary endpoint. Monomorphic VTs were found in 66.7% patients and were terminated by antitachycardia pacing therapy. One patient with polymorphic VT and two patients with VF received adequate therapy by an ICD-shock. However, inducibility did not correlate with the occurrence of endpoints.ConclusionInducibilty during programmed ventricular stimulation is associated with positive late gadolinium enhancement in cardiac MRI of patients with non-ischemic dilated cardiomyopathy. The presence of myocardial fibrosis or inflammation in undirected endomyocardial biopsy does not seem to be sufficient to predict future ventricular arrhythmias.

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“…6,24,25 Ventricular tachycarrhythmia inducibility during EPS was defined as induction of either sustained monomorphic VT or/and polymorphic VT degenerating into VF.…”

Section: Electrophysiological Studymentioning

confidence: 99%

Deceleration Capacity of Heart Rate Predicts Arrhythmic and Total Mortality in Heart Failure Patients

Αρσένος

Manis

Gatzoulis

et al. 2016

Noninvasive Electrocardiol

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Prognostic value of programmed ventricular stimulation for sudden death in selected high risk patients with structural heart disease and preserved systolic function

Cited by 40 publications

References 9 publications

2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

Comparison of Ventricular Inducibility with Late Gadolinium Enhancement and Myocardial Inflammation in Endomyocardial Biopsy in Patients with Dilated Cardiomyopathy

Deceleration Capacity of Heart Rate Predicts Arrhythmic and Total Mortality in Heart Failure Patients

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