Ambulatory Ventricular Arrhythmias in Patients With Heart Failure Do Not Specifically Predict an Increased Risk of Sudden Death

Teerlink, John R.; Jalaluddin, Muhammad; Anderson, Susan; Kukin, Marrick; Eichhorn, Eric J.; Francis, Gary S.; Packer, Milton; Massie, Barry M.

doi:10.1161/01.cir.101.1.40

Cited by 193 publications

(108 citation statements)

References 15 publications

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“…Yet, this is not entirely true, because several shocks and/or antitachycardia pacing may treat arrhythmic episodes that would resolve spontaneously and not necessarily evolve to death 19,20 .…”

Section: Discussionmentioning

confidence: 99%

“…The protocol for ventricular stimulation was performed at the cycle lengths of 600, 500, and 430 ms using up to three extrastimuli delivered to the right ventricular apex and outflow tract, until a sustained ventricular arrhythmia was induced or not, as described in previous studies published in the literature 16,19 . Inducible sustained ventricular arrhythmia at EPS was defined as monomorphic ventricular tachycardia, polymorphic ventricular tachycardia or ventricular fibrillation lasting 30 seconds or longer during the programmed ventricular stimulation, at any cycle, at the right ventricle apex or outflow tract and that reverted spontaneously or could be reverted with rapid ventricular stimulation or external defibrillation.…”

mentioning

confidence: 99%

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Acompanhamento clínico de pacientes portadores de cardioversor-desfibrilador implantável

Fonseca¹,

Belo²,

Carvalho³

et al. 2007

Arq. Bras. Cardiol.

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Objective: To report appropriate (AT) and inappropriate (IT) ICD therapies in patients with ischemic and nonischemic heart disease, as well as early and late procedure-related complications. Methods:One hundred and fifty-five patients (119 male and 36 female), mean age 47 years (21-88), who underwent ICD implantation between 1994 and March 2003 were analyzed. Patients were divided into the following groups: Group I -Post-AMI patients (n = 80); Group II -Patients with nonischemic heart disease and LV ejection fraction < 40% (n = 45), Chagas disease (n = 18), idiopathic dilated cardiomyopathy (n= 12), hypertensive disease (n = 8), hypertrophic cardiomyopathy (n = 4) and valvular heart disease (n = 3); Group III -Patients with arrhythmogenic right ventricular dysplasia (n = 13); and Group IV -Patients with channelopathies: Brugada Syndrome (n = 8) and idiopathic ventricular arrhythmias (n = 9). All patients underwent EPS before ICD implantation.Results: During the 26-month mean follow up, a high rate of appropriate ICD therapies (antitachycardia pacing and/or shock) was observed (46%) in the four groups, with no statistically significant difference. The four groups did not differ in either overall (8.4%) or arrhythmic mortality (1.3%). There was no correlation between appropriate ICD therapies and initial clinical presentation or inducible ventricular arrhythmia at EPS, and a 4% incidence of early and late procedure-related complications was found. Conclusion:The high incidence of appropriate ICD therapy and low rate of sudden death in the patients studied suggest that ICD is a valuable strategy in the management of ischemic and nonischemic patients previously selected by means of EPS.Key words: Sudden death, implantable cardioverter-defibrillator, appropriate and inappropriate discharges, ischemic and nonischemic heart disease.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Acompanhamento clínico de pacientes portadores de cardioversor-desfibrilador implantável

Fonseca¹,

Belo²,

Carvalho³

et al. 2007

Arq. Bras. Cardiol.

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“…Factors associated with at least marginal (p<0.15) univariate predictive value were entered into multiple regression models using measures of atrial or ventricular arrhythmias as dependent variables. As the distribution of continuous Holter variables was skewed, the natural log transformation was applied before statistical analyses were carried out as described by other studies [9,10]. In addition, a logistic regression model was used to test the association of diabetes with the presence of episodes of ventricular tachycardia.…”

Section: Methodsmentioning

confidence: 99%

Diabetes and the occurrence of ventricular arrhythmic events in patients with severe left ventricular dysfunction

Aronson

2002

Diabetologia

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Aims/hypothesis. Diabetes is associated with a higher risk of ischaemic heart disease and heart failure, which frequently lead to rhythm disorders. However, experimental and clinical studies are inconsistent with regard to the risk of arrhythmic events in patients with diabetes. We studied the frequency of ventricular arrhythmic events in patients with and without diabetes. Methods. The study group included 207 patients with severe heart failure. The severity of ventricular arrhythmias was assessed by 24-h Holter monitoring, using prospectively defined measures of ventricular arrhythmic burden. Results. Patients with diabetes comprised 48% of the study group. All measures of ventricular ectopy were much lower in patients with diabetes. Mean hourly ventricular pairs (13.3±3.7 vs 7.2±2.0, p=0.03), mean hourly repetitive ventricular beats (32±9 vs 17±5, p=0.01), and the frequency of ventricular tachycardia episodes per 24 h (36±13 vs 16±6, p=0.01) were lower in patients with diabetes. After inclusion of clinical variables and drug therapies in a multivariate analysis, the negative relationship between diabetes and the frequency of ventricular pairs (p=0.03), repetitive ventricular beats (p=0.04), and ventricular tachycardia (p=0.03) remained independent. In multivariate logistic regression, the risk of developing ventricular tachycardia was lower in patients with diabetes with an adjusted odds ratio of 0.41 (95% CI, 0.22 to 0.75, p=0.004). Conclusion/interpretation. Diabetes confers a protective effect with regard to the occurrence of ventricular arrhythmias in the setting of decompensated heart failure. The precise mechanism of this phenomenon requires further investigation. [Diabetologia (2002[Diabetologia ( ) 45:1440[Diabetologia ( -1445

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“…Występowanie i ciężkość arytmii komorowej zwiększają się wraz z ciężkością HF, ale wartość tych zaburzeń rytmu jako wskaźnika predykcyjnego nagłych zgonów pozostaje niejasna [297][298][299][300]. Identyfikacja zwiększonego ryzyka nagłego zgonu u pacjentów HF stwarza zresztą dobrze znane trudności, a jedyny zgodny i niezależny związek stwierdzono z ciężkością dysfunkcji LV lub LVEF.…”

Section: Ablacja Przezcewnikowaunclassified

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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Ambulatory Ventricular Arrhythmias in Patients With Heart Failure Do Not Specifically Predict an Increased Risk of Sudden Death

Abstract: This study demonstrates that ventricular arrhythmias do not specifically predict sudden death in patients with moderate-to-severe heart failure. Thus, the finding of asymptomatic NSVT on ambulatory ECG does not identify specific candidates for antiarrhythmic or device therapy.

Cited by 193 publications

References 15 publications

Acompanhamento clínico de pacientes portadores de cardioversor-desfibrilador implantável

Acompanhamento clínico de pacientes portadores de cardioversor-desfibrilador implantável

Diabetes and the occurrence of ventricular arrhythmic events in patients with severe left ventricular dysfunction

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

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