Programmed ventricular stimulation in patients with idiopathic dilated cardiomyopathy and syncope receiving implantable cardioverter-defibrillators: a case series and a systematic review of the literature

Background: The role of programmed ventricular stimulation (PVS) in patients with idiopathic dilated cardiomyopathy (DCM) and syncope receiving implantable cardioverter-defibrillators (ICD) remains controversial. Methods and results: Between 1994 and July 2002, 20 patients with DCM and syncope under-went PVS and ICD implantation at the Onassis Cardiac Surgery Center or the Alexandra General Hospital. At PVS 10 patients had inducible sustained monomorphic ventricular tachycardia (SMVT), 3 patients had inducible sustained polymorphic ventricular tachycardia or ventricular fibrillation, and 7 patients had no inducible arrhythmia. The latter 7 patients received an ICD because of clinical occurrence of ventricular tachycardia (n = 5) or fibrillation (n = 2). Mean age was 55 +/- 14 years; 80% were men. During a mean follow-up of 2.8 +/- 2.3 years, 12 of the 20 patients received an appropriate shock. The incidence of appropriate shocks at I and 3 years was 69% and 84% in the inducible SMVT group, and 56% and 67% in the group without inducible SMVT (p = 0.93, log rank test). Overall survival was similar in both groups (p = 0.53). In a systematic review of the published literature 18 of 75 (24%) patients with DCM, syncope and a negative PVS had an appropriate ICD shock after a mean follow-up of 27 months. Conclusion: PVS has a limited role in risk stratification of patients with DCM and syncope. (c) 2004 Elsevier Ireland Ltd. All rights reserved.