Clinical Electrophysiology -> SCA Risk Assessment: -> Clinical Risk Assessment Techniques D-PO04 - Poster Session IV (ID 15) Poster

D-PO04-215 - Non-sustained Ventricular Tachycardia In Nonischemic Dilated Cardiomyopathy: Results From The Leiden Nonischemic Cardiomyopathy Study (ID 500)

Abstract

Background: The underlying substrates of non-sustained ventricular tachycardia (NSVT) in nonischemic dilated cardiomyopathy (DCM) are unclear.
Objective: To characterize NSVT in DCM and analyze its association with late gadolinium enhancement (LGE) on CMR, inducibility of sustained VT during EP study, and ventricular arrhythmias during follow-up.
Methods: In the prospective Leiden Nonischemic Cardiomyopathy Study (ClinicalTrials.gov Identifier: NCT01940081) patients with DCM underwent a comprehensive evaluation. For the present study, 24h-Holters were assessed for the presence of NSVT and its features (number of episodes, rate, rate variability, duration, coupling interval and morphology). CMRs were assessed for the presence of LGE and EP studies for inducibility of sustained monomorphic VT. Patients were followed and ICDs were programmed with therapy >188-200 bpm or adjusted to clinically documented VT.
Results: Of all 148 patients, 95 underwent a 24-hour Holter and were included in the present study (age 59±13 years, 76% male, history of sustained VT in 26 [27%] and OHCA in 7 [9%]). NSVT was observed during Holter in 52 patients (55%). NSVT was not associated with LGE on CMR (p=0.49) or VT inducibility during EP study (p=0.96), nor were its features (all p>0.05). During 4.0±1.7 years follow-up, sustained ventricular arrhythmia occurred in 30 patients (32%). NSVT was associated with a higher rate of sustained VT during follow-up (HR 5.45, p=0.002), but not with polymorphic VT/VF (p=0.69). Similarly, inducibility of sustained VT during EP study was also associated with sustained VT (HR 5.78, p<0.001), but not with polymorphic VT/VF (p=0.13). The findings remained similar when only primary prevention patients were included. In multivariate analysis, NSVT on Holter and inducibility of sustained VT both remained independently associated with sustained VT during follow-up (all p≤0.001), but not with polymorphic VT/VF.
Conclusion: In DCM, NSVT on Holter and inducible sustained VT during EP study are not directly interrelated, but both predict the occurrence of sustained VT during follow-up. These data suggest that non-sustained and sustained VT may have different underlying mechanisms and provide complementary information in DCM.
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