Rapid-rate Non-sustained Ventricular Tachycardias Documentation in
Implantable Cardioverter-Defibrillator Predicts the Occurrence of
Ventricular Tachyarrhythmia in Patients with Dilated Cardiomyopathy
Abstract
Aims Non-sustained ventricular tachycardia (NSVT) occurs frequently in
patients with dilated cardiomyopathy (DCM), especially in high-risk
patients. The role of rapid-rate NSVT (RR-NSVT) documented by an
implantable cardioverter defibrillator (ICD) in DCM patients has not
been fully explored. This study aimed to determine the relationship
between RR-NSVT and the occurrence of ventricular tachyarrhythmias
(VTAs) in DCM patients with ICD. Methods From December 2000 to December
2017, 136 DCM patients received ICD or cardiac resynchronization therapy
defibrillator (CRT-D) implantation for primary or secondary prevention
of VTAs. Based on the occurrence of documented RR-NSVT, patients were
classified into RR-NSVT (-) or RR-NSVT (+) groups. Result During the
median follow-up of 4.5 years, 50.0% (68/136) of patients experienced ≥
1 episode, and 25.0% (34/136) of patients experienced ≥ 3 episodes of
RR-NSVT. Event-free survival for VTAs was significantly higher in the
RR-NSVT (+) group whereas those for heart failure admission and
cardiovascular mortality were comparable between groups. In the
multivariate cox regression analysis, any RR-NSVT showed a positive
association with the occurrence of VTAs (HR: 5.087; 95% CI:
2.374-10.900; p<0.001). In RR-NSVT (+) patients, a cluster (≥
3 times/6 months) and frequent pattern (≥ 3 runs/day) of RR-NSVT were
observed in 42.6% (29/68) and 30.9% (21/68) of patients, respectively,
who showed further increased incidence of VTAs. Conclusion In DCM
patients with ICD/CRT-D, 50.0% experienced at least 1 episode of
RR-NSVT. RR-NSVT documentation showed a positive association with
subsequent occurrence of VTAs, suggesting the importance of constructive
arrhythmia management for patients with RR-NSVT.