Programmed ventricular stimulation in structural heart disease: Implications of patterns of ventricular arrhythmias induced to long-term outcomes

Singh, Gurbhej; Prasad, Srinivasa R.; Namboodiri, Narayanan; Thajudeen, Anees; Nair, Krishna Kumar Mohanan; Abhilash, Sreevilasam Pushpangadhan; Tharakan, Jaganmohan A.; Vk, Ajit Kumar

doi:10.1016/j.ihj.2022.12.002

Cited by 1 publication

(4 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The most current guidelines on syncope and sudden death prevention support the use of electrophysiologic study with programmed ventricular pacing for risk stratification of patients with syncope. The guideline of the American Heart Association classifies as recommendation class IIa, level of evidence B, the performance of EPS with ventricular pacing for patients with syncope and ischemic heart disease, nonischemic dilated heart disease or adults with congenital heart disease who do not meet criteria for ICD as primary prevention 18 . The European Society of Cardiology guideline describes as a strong prognostic factor the induction of sustained monomorphic ventricular arrhythmias in patients with previous myocardial infarction, whereas the induction of ventricular fibrillation is considered a nonspecific finding.…”

Section: Discussionmentioning

confidence: 99%

“…Similar findings were demonstrated by Mittel S et al 17 who presented that in patients with ischemic heart disease and syncope of undetermined origin, the induction of VF with programmed pacing showed no difference in patient survival during follow-up, demonstrating a low specificity of the induction of this ventricular arrhythmia morphology, especially when using more aggressive pacing protocols, with three extrastimuli. 18 conducted a retrospective study analyzing the induction of ventricular arrhythmias in patients with structural heart disease. They showed that the induction of ventricular arrhythmias was associated with the occurrence of ischemic heart disease and left ventricular dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…Gurbhej Singh and colleagues 18 conducted a retrospective study analyzing the induction of ventricular arrhythmias in patients with structural heart disease. They showed that the induction of ventricular arrhythmias was associated with the occurrence of ischemic heart disease and left ventricular dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…The guideline of the American Heart Association classifies as recommendation class IIa, level of evidence B, the performance of EPS with ventricular pacing for patients with syncope and ischemic heart disease, nonischemic dilated heart disease or adults with congenital heart disease who do not meet criteria for ICD as primary prevention. 18 The European Society of Cardiology guideline describes as a strong prognostic factor the induction of sustained monomorphic ventricular arrhythmias in patients with previous myocardial infarction, whereas the induction of ventricular fibrillation is considered a nonspecific finding. They classify as recommendation class I, level of evidence B, the performance of EPS in patients with syncope and previous infarction, with inconclusive non‐invasive investigation, and recommendation class IIb, level of evidence C, for patients with syncope preceded by palpitations.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Prognosis of programmed ventricular stimulation in adult patients with syncope of unexplained origin: A historical cohort

Finkler,

Sant'Anna,

Pinos

et al. 2023

Journal of Arrhythmia

View full text Add to dashboard Cite

BackgroundProgrammed ventricular stimulation (PVS) during electrophysiological study (EPS), is a globally accepted tool for risk stratification of sudden cardiac death (SCD) in some specific clinical situations. The aim of this study was to evaluate the prognosis of ventricular arrhythmia induction in a cohort of patients with syncope of undetermined origin (SUO).MethodsThis is a historical cohort study in a population of patients with SUO referred for EPS between the years 2008–2021. In this interval, 575 patients underwent the procedure.ResultsPatients with induced ventricular arrhythmias had a higher occurrence of structural heart disease (36.7% vs. 76.5%), ischemic heart disease (28.2 vs. 57.1%), heart failure (15.5% vs. 34.4%), and lower left ventricular ejection fraction (59.16% vs. 47.51%), when compared to the outcome with a negative study. PVS triggered ventricular arrhythmias in 98 patients, 62 monomorphic and 36 polymorphic. During a median follow‐up of 37.6 months, 100 deaths occurred. Only the induction of sustained ventricular arrhythmias showed a significant association with the primary outcome (all‐cause mortality) with a p value <.001. After the performance of EPS, 142 patients underwent cardioverter‐defibrillator (ICD) implantation. At study follow‐up, 30 patients had therapies by the device. Only the induction of sustained monomorphic ventricular arrhythmia showed statistically significant association with appropriate therapies by the device (p = .012).ConclusionIn patients with SUO, the induction of sustained monomorphic ventricular arrhythmia after programmed ventricular pacing is related to a worse prognosis, with a higher incidence of mortality and appropriate therapies by the ICD.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations