Prevalence and prognostic association of ventricular arrhythmia in non-ischaemic heart failure patients: results from the DANISH trial. Issue 4 (30th November 2020)

• Record Type: Journal Article
• Authors: Boas, Rune; Thune, Jens Jakob; Pehrson, Steen; Køber, Lars; Nielsen, Jens C; Videbæk, Lars; Haarbo, Jens; Korup, Eva; Bruun, Niels Eske; Brandes, Axel; Eiskjær, Hans; Thøgersen, Anna M; Philbert, Berit T; Svendsen, Jesper Hastrup; Dixen, Ulrik
• Is Part Of: Europace. Volume 23:Issue 4(2021)
• Page Start: 587
• Page End: 595
• Publication Date: 2020-11-30
• Subjects: Non-ischaemic heart failure -- Ventricular arrhythmia -- Implantable cardioverter-defibrillator -- Non-sustained ventricular tachycardia -- Premature ventricular contractions; Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euaa341
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Aims: Improved risk stratification to identify non-ischaemic heart failure patients who will benefit from primary prophylactic implantable cardioverter-defibrillator (ICD) is needed. We examined the potential of ventricular arrhythmia to identify patients who could benefit from an ICD. Methods and results: A total of 850 non-ischaemic systolic heart failure patients with left ventricle ≤35% and elevated N-terminal pro-brain natriuretic peptides had a 24-h Holter monitor recording performed. We examined present non-sustained ventricular tachycardia (NSVT), defined as ≥3 consecutive premature ventricular contractions (PVCs) with a rate of ≥100/min, and number of PVCs per hour stratified into low (<30) and high burden (≥30) groups. Outcome measures were overall mortality, sudden cardiac death (SCD), and cardiovascular death (CVD). In total, 193 patients died, 49 from SCD and 125 from CVD. Non-sustained ventricular tachycardia (365 patients) was significantly associated with increased all-cause mortality [hazard ratio (HR) 1.47; 95% confidence interval (CI) 1.07–2.03; P = 0.02] and to CVD (HR 1.89; CI 1.25–2.87; P = 0.003). High burden PVC (352 patients) was associated with increased all-cause mortality (HR1.38; CI 1.00–1.90; P = 0.046) and with CVD (HR 1.78; CI 1.19–2.66; P = 0.005). There was no statistically significant association with SCD for neither NSVT nor PVC. In interaction analyses, neither NSVT ( P = 0.56) nor high burden of PVC ( P = 0.97) was associated with survival benefit from ICD implantation. Conclusion: Ventricular arrhythmia in non-ischaemic heart failure patients was associated with a worse prognosis but could not be used to stratify patients to ICD implantation.