Arrhythmic risk stratification in heart failure mid‐range ejection fraction patients with a non‐invasive guiding to programmed ventricular stimulation two‐step approach

Autor: Petros Arsenos, Konstantinos A. Gatzoulis, Ioannis Doundoulakis, Polychronis Dilaveris, Christos‐Konstantinos Antoniou, Soulaidopoulos Stergios, Skevos Sideris, Sotiropoulos Ilias, Dimitrios Tousoulis
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Zdroj: Journal of Arrhythmia, Vol 36, Iss 5, Pp 890-898 (2020)
Druh dokumentu: article
ISSN: 1883-2148
1880-4276
DOI: 10.1002/joa3.12416
Popis: Abstract Background Although some post myocardial infarction (post‐MI) and dilated cardiomyopathy (DCM) patients with mid‐range ejection fraction heart failure (HFmrEF/40%‐49%) face an increased risk for arrhythmic sudden cardiac death (SCD), current guidelines do not recommend an implantable cardiac defibrilator (ICD). We risk stratified hospitalized HFmrEF patients for SCD with a combined non‐invasive risk factors (NIRFs) guiding to programmed ventricular stimulation (PVS) two‐step approach. Methods Forty‐eight patients (male = 83%, age = 64 ± 14 years, LVEF = 45 ± 5%, CAD = 69%, DCM = 31%) underwent a NIRFs screening first‐step with electrocardiogram (ECG), SAECG, Echocardiography and 24‐hour ambulatory ECG (AECG). Thirty‐two patients with presence of one of three NIRFs (SAECG ≥ 2 positive criteria for late potentials, ventricular premature beats ≥ 240/24 hours, and non‐sustained ventricular tachycardia [VT] episode ≥ 1/24 hours) were further investigated with PVS. Patients were classified as either low risk (Group 1, n = 16, NIRFs−), moderate risk (Group 2, n = 18, NIRFs+/PVS−), and high risk (Group 3, n = 14, NIRFs+/PVS+). All in Group 3 received an ICD. Results After 41 ± 18 months, 9 of 48 patients, experienced the major arrhythmic event (MAE) endpoint (clinical VT/fibrillation = 3, appropriate ICD activation = 6). The endpoint occurred more frequently in Group 3 (7/14, 50%) than in Groups 1 and 2 (2/34, 5.8%). Logistic regression model adjusted for PVS, age, and LVEF revealed that PVS was an independent MAE predictor (OR: 21.152, 95% CI: 2.618‐170.887, P = .004). Kaplan‐Meier curves diverged significantly (log rank, P
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