Futyma P, Sander J, Głuszczyk R, Maciołek M, Futyma M, Kułakowski P. Prognostic value of noninvasive programmed stimulation in patients with implantable cardioverter defibrillator.
Pacing Clin Electrophysiol 2018;
41:1643-1651. [PMID:
30302762 DOI:
10.1111/pace.13523]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 10/01/2018] [Accepted: 10/03/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND
Implantable cardioverter defibrillator (ICD) offers an opportunity to examine vulnerability to ventricular tachycardia (VT) or ventricular fibrillation (VF) by performing noninvasive programmed ventricular stimulation (NIPS). Whether NIPS can predict VT/VF recurrences has not yet been established.
PURPOSE
To examine the predictive value of NIPS for identification of patients with VT/VF recurrences.
METHODS
The study group consisted of consecutive 105 ICD recipients included in the prospective NIPS-ICD study (ClinicalTrials ID: NCT02373306) (88 males, age 65 ± 11 years). The patients underwent NIPS using the protocol up to three premature extrastimuli at 600-500- and 400-ms drive cycle lengths. The endpoint of NIPS was induction of sustained VT or VF or completion of the protocol.
RESULTS
VT/VF was induced in 29 (27.6%) patients. During a 12-month follow-up NIPS-inducible patients had significantly more frequently appropriate ICD therapy than noninducible patients (17% vs 4%, P = 0.023). NIPS-induced VT/VF had a sensitivity of 63%, specificity of 75%, positive predictive value of 17%, and negative predictive value of 96% for identification of patients with future VT/VF. Apart from NIPS, age ≥ 65 years, QRS duration, treatment with angiotensin-converting enzyme, history of coronary artery bypass grafting, history of VT/VF prior to NIPS, and prior appropriate ICD therapy were also associated with VT/VF recurrences. Multivariate analysis showed that, together with QRS duration, NIPS result was an independent predictor of future VT/VF. Predictive value of NIPS was significantly higher in ischemic than nonischemic patients.
CONCLUSIONS
NIPS result is associated with future VT/VF. Noninducibility at NIPS identifies those patients with high accuracy who will have uneventful follow-up.
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