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. 2020 Nov 28;37(1):148-156.
doi: 10.1002/joa3.12468. eCollection 2021 Feb.

Current status and role of programmed ventricular stimulation in patients without sustained ventricular arrhythmias and reduced ejection fraction: Analysis of the Japan cardiac device treatment registry database

Hisashi Yokoshiki  1 , Akihiko Shimizu  2 , Takeshi Mitsuhashi  3 , Kohei Ishibashi  4 , Tomoyuki Kabutoya  5 , Yasuhiro Yoshiga  6 , Ritsuko Kohno  7 , Haruhiko Abe  7 , Akihiko Nogami  8 ; Members of the Implantable Cardioverter‐Defibrillator (ICD) Committee of the Japanese Heart Rhythm Society
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Current status and role of programmed ventricular stimulation in patients without sustained ventricular arrhythmias and reduced ejection fraction: Analysis of the Japan cardiac device treatment registry database

Hisashi Yokoshiki et al. J Arrhythm. .

Abstract

Background: The aim of this study was to clarify the current status and role of programmed ventricular stimulation in patients without sustained ventricular arrhythmias and reduced left ventricular ejection fraction (LVEF).

Methods: The follow-up data of the Japan cardiac device treatment registry (JCDTR) was analyzed in 746 patients with LVEF ≦35% and no prior history of sustained ventricular arrhythmias who underwent de novo implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy with a defibrillator (CRT-D) implantation between January 2011 and August 2015.

Results: Electrophysiological study (EPS) with programmed ventricular stimulation had been performed before the device implant in 118 patients (15.8%, EPS group). During the mean follow-up of 21 ± 12 months, the rate of freedom from any death and appropriate defibrillator therapy was not significantly different between EPS group (n = 118) and No EPS group (n = 628). NYHA class II-IV, and QRS duration were negatively associated with performing EPS. Among patients in the EPS group, the rate of ventricular tachycardia (VT)/ventricular fibrillation (VF) induction was 48%. The inducibility was not a predictor of appropriate defibrillator therapy, whereas BNP ≧535 pg/mL and no use of amiodarone were significantly associated with a risk of the appropriate therapy.

Conclusion: EPS for induction of VT/VF had been performed in about 16% of patients with reduced LVEF before primary prevention ICD/CRT-D implantation. Elevated BNP levels and no use of amiodarone, but not inducibility of VT/VF, appeared to be associated with appropriate defibrillator therapy in these populations.

Keywords: cardiac resynchronization therapy with a defibrillator (CRT‐D); electrophysiological study (EPS); implantable cardioverter‐defibrillator (ICD); primary prevention; ventricular fibrillation (VF); ventricular tachycardia (VT).

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Conflict of interest statement

All authors declare no conflict of interest related to this study.

Figures

FIGURE 1
FIGURE 1
Kaplan‐Meier estimates of event‐free survival in ICD/CRT‐D recipients for primary prevention of sudden cardiac death with and without performing EPS before the implantation. Outcome events were death from any cause (A), heart failure death (B), appropriate defibrillator therapy (C) and inappropriate defibrillator therapy (D)
FIGURE 2
FIGURE 2
Kaplan‐Meier estimates of event‐free survival in ICD/CRT‐D recipients for primary prevention of sudden cardiac death with and without VT/VF induction. Outcome events were death from any cause (A), and appropriate defibrillator therapy (B)
FIGURE 3
FIGURE 3
Kaplan‐Meier estimates of freedom from appropriate defibrillator therapy among ICD/CRT‐D recipients for primary prevention of sudden cardiac death who underwent EPS, stratified by BNP levels (A) and amiodarone use (B)
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