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. 2020 Mar 17;25(1):5.
doi: 10.1186/s40001-020-0401-x.

Clinical significance of precedent asymptomatic non-sustained ventricular tachycardias on subsequent ICD interventions and heart failure hospitalization in primary prevention ICD patients

Hisaki Makimoto  1   2 , Sophie Zielke  3 , Lukas Clasen  3   4 , Tina Lin  5 , Shqipe Gerguri  3 , Patrick Müller  3 , Jan Schmidt  3 , Alexandru Bejinariu  3 , Muhammed Kurt  3 , Christoph Brinkmeyer  3 , Manuel Stern  3 , Malte Kelm  3   4 , Alexander Fürnkranz  3
Affiliations

Clinical significance of precedent asymptomatic non-sustained ventricular tachycardias on subsequent ICD interventions and heart failure hospitalization in primary prevention ICD patients

Hisaki Makimoto et al. Eur J Med Res. .

Abstract

Background: The prognostic implications of non-sustained ventricular tachycardia (NSVT) and their significance as therapeutic targets in patients without prior sustained ventricular arrhythmias remain undetermined. The aim of this study was to investigate the prognostic significance of asymptomatic NSVT in patients who had primary prevention implantable cardioverter-defibrillator (ICD) implantation due to ischemic or non-ischemic cardiomyopathy (ICM, NICM).

Methods: We enrolled 157 consecutive primary prevention ICD patients without previous appropriate ICD therapy (AIT). Patients were allocated to two groups depending on the presence or absence of NSVT in a 6-month period prior to enrollment. The incidence of AIT and unplanned hospitalization due to decompensated heart failure (HF) were assessed during follow-up.

Results: In 51 patients (32%), precedent NSVT was documented. During a median follow-up of 1011 days, AIT occurred in 36 patients (23%) and unplanned HF hospitalization was observed in 32 patients (20%). In precedent NSVT patients, the incidence of AIT and unplanned HF hospitalization was significantly higher as compared to patients without precedent NSVT (AIT: 29/51 [57%] vs. 7/106 [7%], P < 0.001, log-rank; HF hospitalization: 16/51 [31%] vs. 16/106 [15%], P = 0.043, log-rank). Cox-regression demonstrated that precedent NSVT independently predicted AIT (P < 0.0001). In subgroup analyses, precedent NSVT predicted AIT in both ICM and NICM (P < 0.0001, P = 0.020), but predicted HF hospitalization only in patients with ICM (P = 0.0030).

Conclusions: Precedent non-sustained VT in patients with primary prevention ICDs is associated with subsequent appropriate ICD therapies, and is an independent predictor of unplanned heart failure hospitalizations in patients with ischemic cardiomyopathy.

Keywords: Implantable cardioverter-defibrillator; Ischemic cardiomyopathy; Non-ischemic cardiomyopathy; Non-sustained ventricular tachycardia.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan–Meier analysis of appropriate ICD therapy according to the presence of precedent non-sustained ventricular tachycardia. Precedent non-sustained ventricular tachycardia (NSVT) predicted subsequent occurrences of appropriate ICD therapy (log-rank, P < 0.0001)
Fig. 2
Fig. 2
Subgroup Kaplan–Meier analyses of appropriate ICD therapy according to the presence of precedent non-sustained ventricular tachycardia. In both patients with ischemic (a) and non-ischemic cardiomyopathy (b), precedent non-sustained ventricular tachycardia was associated with subsequent appropriate ICD therapy (log-rank, P < 0.0001, and P = 0.0083, respectively)
Fig. 3
Fig. 3
Kaplan–Meier analysis of unplanned hospitalization due to worsening heart failure according to the presence of precedent non-sustained ventricular tachycardia. Precedent non-sustained ventricular tachycardia (NSVT) predicted unplanned hospitalizations due to heart failure (HF) during follow-up (a log-rank, P = 0.043). In subgroup analyses, precedent NSVT was associated with higher unplanned HF hospitalization rates in patients with ischemic cardiomyopathy (b log-rank, P = 0.011), but not in patients with non-ischemic cardiomyopathy (c log-rank, P = 0.75)
Fig. 4
Fig. 4
Kaplan–Meier analysis of all-cause mortality according to the presence of precedent non-sustained ventricular tachycardia. There was no significant difference in all-cause mortality between patients with and without precedent non-sustained ventricular tachycardia (P = 0.48)
See this image and copyright information in PMC

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