Journal
EUROPACE
Volume 23, Issue 4, Pages 587-595Publisher
OXFORD UNIV PRESS
DOI: 10.1093/europace/euaa341
Keywords
Non-ischaemic heart failure; Ventricular arrhythmia; Implantable cardioverter-defibrillator; Non-sustained ventricular tachycardia; Premature ventricular contractions
Categories
Funding
- Danish Heart Foundation [17-R116-A7647-22064]
- Hospital's Independent Research Funds, Copenhagen University Hospital Amager and Hvidovre, Denmark
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This study found that ventricular arrhythmia in non-ischaemic heart failure patients was associated with a worse prognosis but could not be used to stratify patients for ICD implantation.
Aims Improved risk stratification to identify non-ischaemic heart failure patients who will benefit from primary prophylactic implantable cardioverter-defibrillator (ICD) is needed. We examined the potential of ventricular arrhythmia to identify patients who could benefit from an ICD. Methods and results A total of 850 non-ischaemic systolic heart failure patients with left ventricle <_35% and elevated N-terminal pro-brain natriuretic peptides had a 24-h Holter monitor recording performed. We examined present non-sustained ventricular tachycardia (NSVT), defined as >= 3 consecutive premature ventricular contractions (PVCs) with a rate of >= 100/min, and number of PVCs per hour stratified into low (<30) and high burden (>= 30) groups. Outcome measures were overall mortality, sudden cardiac death (SCD), and cardiovascular death (CVD). In total, 193 patients died, 49 from SCD and 125 from CVD. Non-sustained ventricular tachycardia (365 patients) was significantly associated with increased all-cause mortality [hazard ratio (HR) 1.47; 95% confidence interval (CI) 1.07-2.03; P = 0.02] and to CVD (HR 1.89; CI 1.25-2.87; P = 0.003). High burden PVC (352 patients) was associated with increased all-cause mortality (HR1.38; CI 1.00-1.90; P = 0.046) and with CVD (HR 1.78; CI 1.19-2.66; P = 0.005). There was no statistically significant association with SCD for neither NSVT nor PVC. In interaction analyses, neither NSVT (P= 0.56) nor high burden of PVC (P= 0.97) was associated with survival benefit from ICD implantation. Conclusion Ventricular arrhythmia in non-ischaemic heart failure patients was associated with a worse prognosis but could not be used to stratify patients to ICD implantation.
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