Ventricular arrhythmia inducibility predicts subsequent ICD activation in nonischemic cardiomyopathy patients

James P. Daubert, Stephen L. Winters, Haris SubaČius, Ronald D. Berger, Kenneth A. Ellenbogen, Sarah G. Taylor, Andi Schaechter, Adam Howard, Alan Kadish

Research output: Contribution to journalArticle

Abstract

Objectives: We evaluated whether electrophysiologic (EP) inducibility predicts the subsequent occurrence of spontaneous ventricular tachycardia (VT) or ventricular fibrillation (VF) in the Defibrillators in Nonischemic Cardiomyopathy Treatment Evaluation (DEFINITE) trial. Background: Inducibility of ventricular arrhythmias has been widely used as a risk marker to select implantable cardioverter defibrillator (ICD) candidates, but is believed not to be predictive in nonischemic cardiomyopathy patients. Methods: In DEFINITE, patients randomized to the ICD arm, but not the conventional arm, underwent noninvasive EP testing via the ICD shortly after ICD implantation using up to three extrastimuli at three cycle lengths plus burst pacing. Inducibility was defined as monomorphic or polymorphic VT or VF lasting 15 seconds. Patients were followed for a median of 29 ± 14 months (interquartile range = 2-41). An independent committee, blinded to inducibility status, characterized the rhythm triggering ICD shocks. Results: Inducibility, found in 29 of 204 patients (VT in 13, VF in 16), was associated with diabetes (41.4% vs 20.6%, P = 0.014) and a slightly higher ejection fraction (23.2 ± 5.9 vs 20.5 ± 5.7, P = 0.021). In follow-up, 34.5% of the inducible group (10 of 29) experienced ICD therapy for VT or VF or arrhythmic death versus 12.0% (21 of 175) noninducible patients (hazard ratio = 2.60, P = 0.014). Conclusions: In DEFINITE patients, inducibility of either VT or VF was associated with an increased likelihood of subsequent ICD therapy for VT or VF, and should be one factor considered in risk stratifying nonischemic cardiomyopathy patients. (PACE 2009; 32:755-761)

Original languageEnglish (US)
Pages (from-to)755-761
Number of pages7
JournalPACE - Pacing and Clinical Electrophysiology
Volume32
Issue number6
DOIs
StatePublished - Jun 1 2009

    Fingerprint

Keywords

  • Congestive heart failure
  • Dilated cardiomyopathy
  • Electrophysiology clinical
  • ICD
  • Left ventricular dysfunction
  • Physiopathology
  • Sudden cardiac death
  • Ventricular fibrillation
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Daubert, J. P., Winters, S. L., SubaČius, H., Berger, R. D., Ellenbogen, K. A., Taylor, S. G., Schaechter, A., Howard, A., & Kadish, A. (2009). Ventricular arrhythmia inducibility predicts subsequent ICD activation in nonischemic cardiomyopathy patients. PACE - Pacing and Clinical Electrophysiology, 32(6), 755-761. https://doi.org/10.1111/j.1540-8159.2009.02362.x