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Ventricular tachyarrhythmia recurrence in primary versus secondary implantable cardioverter-defibrillator patients and role of electrophysiology study

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Abstract

Purpose

In recent years, there has been a shift away from performing electrophysiologic study (EPS) to guide implantable cardioverter-defibrillator (ICD) implantation with a reliance on left ventricular ejection fraction (LVEF) alone.

Methods

ICD patients were prospectively recruited from the multicentre COMFORT (Concept of Optimal Management of ventricular Fibrillation Or Very fast ventricular Tachycardia) trial. Primary prevention ICD patients (n = 260, groups 1 and 2) were compared to secondary prevention ICD patients (n = 210, group 3). Primary prevention ICDs were implanted in patients with ischemic cardiomyopathy based on LVEF ≤ 40 % and inducible ventricular tachycardia (VT) at EPS (n = 123, group 1) or impaired LVEF alone (LVEF ≤ 30 % or LVEF ≤ 35 % with NYHA class II or III; n = 137, group 2). EPS was performed in 61 % of secondary prevention ICD patients (n = 129). Patients were followed up for >12 months with a primary endpoint of spontaneous VT/ventricular fibrillation (VF).

Results

A significantly higher rate of spontaneous VT/VF occurred in secondary versus primary prevention ICD patients (P < 0.001) and in EPS-guided versus LVEF-guided primary prevention ICD patients (P = 0.029). At 2 years, the proportion of patients with ≥1 VT/VF episode was 24.6 ± 4.2 %, 19.9 ± 4.6 % and 37.1 ± 3.9 % for groups 1, 2 and 3, respectively. In the secondary prevention, patients who underwent EPS, VT/VF occurred in 44.4 ± 5.9 % and 14.1 ± 6.6 % with a positive versus negative result, respectively (P = 0.02).

Conclusions

Secondary prevention ICD patients have more spontaneous VT/VF than primary prevention ICD patients. Secondary and primary prevention ICD patients with inducible VT at EPS have more VT/VF than patients without inducible VT or impaired LVEF alone.

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Acknowledgments

We would like to thank Flavia Ng, Janice Sullivan, Anne Mitchell, Tom Christensen, Steve Graves, Suzanne, Clem Lee, Catrina Codd and Michelle Roch for their time and dedication. We also thank Dr. Henri Heynen, Clinical Trials and Research Manager at Medtronic, for providing support during the trial.

Funding

This work was supported by an unrestricted grant provided by Medtronic Australia to Westmead Millennium Institute. Dr. Sivangabalan was supported by an Australian Postgraduate Award. Dr. Chik was supported by a medical research scholarship from the Royal Australasian College of Physicians, the Cardiac Society of Australia and New Zealand and the University of Sydney. No other financial disclosures for the other authors.

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Authors and Affiliations

  1. Department of Cardiology, Westmead Hospital, Sydney, NSW, 2145, Australia

    Sarah Zaman, Gopal Sivagangabalan, William Chik & Pramesh Kovoor

  2. Department of Cardiology, St. Andrew’s War Memorial Hospital, Brisbane, Australia

    Wayne Stafford & John Hayes

  3. Department of Cardiology, Prince Charles Hospital, Brisbane, Australia

    Russell Denman

  4. Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia

    Glenn Young & Prashanthan Sanders

  5. Sydney Medical School, University of Sydney, Sydney, Australia

    Sarah Zaman, Gopal Sivagangabalan, William Chik & Pramesh Kovoor

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  1. Sarah Zaman
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  2. Gopal Sivagangabalan
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  9. Pramesh Kovoor
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Correspondence to Pramesh Kovoor.

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Zaman, S., Sivagangabalan, G., Chik, W. et al. Ventricular tachyarrhythmia recurrence in primary versus secondary implantable cardioverter-defibrillator patients and role of electrophysiology study. J Interv Card Electrophysiol 41, 195–202 (2014). https://doi.org/10.1007/s10840-014-9941-8

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  • DOI: https://doi.org/10.1007/s10840-014-9941-8

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