Prognostic significance of non-sustained ventricular tachycardia on stored electrograms in pacemaker recipients


Autoři: Gianluigi Bencardino aff001;  Francesco Raffaele Spera aff001;  Gaetano Pinnacchio aff001;  Francesco Perna aff001;  Maria Lucia Narducci aff001;  Gianluca Comerci aff001;  Gemma Pelargonio aff001;  Francesca Augusta Gabrielli aff001;  Giulio La Rosa aff001;  Gaetano Antonio Lanza aff001;  Filippo Crea aff001
Působiště autorů: Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy aff001;  Università Cattolica del Sacro Cuore, Roma, Italy aff002
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225059

Souhrn

Background

Little is known about the prognostic significance of non-sustained ventricular tachycardia (NS-VT) in outpatients scheduled for routine pacemaker controls. We therefore sought to investigate the prognostic significance of non-sustained ventricular tachycardia on stored electrograms in pacemaker recipients.

Methods

We enrolled patients implanted with dual chamber pacemaker for atrioventricular block or sinus node dysfunction from 2010 to 2016, with LVEF> 45%, older than 18 years, with at least 3 device interrogations at follow-up. Data were collected about medical history, pharmacological therapy at implantation, pacemaker programming, NS-VT occurrence, long-term survival.

Results

A total of 308 patients were included in the final analysis, with median follow-up time of 56 months. No ventricular arrhythmic episodes were documented in 221 patients (Group 1), whereas 87 had at least 1 episode of NS-VT during follow-up (Group 2). As a whole, 282 episodes of NS-VT were documented. There was a higher prevalence of previous myocardial infarction and slightly lower left ventricular ejection fraction (LVEF) in Group 2. The primary endpoint (all-cause mortality) occurred in 50 patients (22%) of Group 1 and 12 (14%) patients of Group 2 (p = 0.07). Clinical predictors of all-cause mortality at univariate analysis included age, LVEF and coronary artery disease (CAD). Only age and CAD, however, remained as predictors of mortality at multivariable analysis. A sizeable, but not statistically significant, portion of patients who died had a de novo occurrence of NS-VT at the last pacemaker check.

Conclusion

Our data do not support a prognostic role for the detection of NS-VT during pacemaker controls.

Klíčová slova:

Arrhythmia – Cardiac pacing – Coronary heart disease – Ejection fraction – Medical devices and equipment – Medical implants – Pacemakers – Tachycardia


Zdroje

1. Larrson B, Elmqvist H, Ryden L, Ryden L, Schuller H. Lessons from the first patient with an implanted pacemaker. PACE 2003; 26:114–124. doi: 10.1046/j.1460-9592.2003.00162.x 12685152

2. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002; 346:877–883. doi: 10.1056/NEJMoa013474 11907286

3. Buxton AE, Lee KL, Fisher JD, Josephson ME, Prystowsky EN, Hafley G. Prevention of sudden death in patients with coronary artery disease: the Multicenter Unsustained Tachycardia Trial (MUSTT). Prog Cardiovasc Dis 1993; 36:215–226. doi: 10.1016/0033-0620(93)90015-6 8234775

4. Zhou X, Gunderson BD, Olson WH. Incidence of Nonsustained and Sustained Ventricular Tachyarrhythmias in Patients with an Implantable Cardioverter Defibrillator. J Cardiovasc Electrophysiol 2004; 15:14–20. doi: 10.1046/j.1540-8167.2004.03154.x 15028067

5. Cheema AN, Sheu K, Parker M, Kadish AH, Goldberger JJ. Nonsustained ventricular tachycardia in the setting of acute myocardial infarction: Tachycardia characteristics and their prognostic implications. Circulation 1998; 98:2030–2036. doi: 10.1161/01.cir.98.19.2030 9808601

6. Mittal S, Lomnitz DJ, Mirchandani S, Stein KM, Markowitz SM, Slotwiner DJ et al. Prognostic significance of nonsustained ventricular tachycardia after revascularization. J Cardiovasc Electrophysiol 2002; 13:342–346. doi: 10.1046/j.1540-8167.2002.00342.x 12033350

7. Mammarella A, Paradiso M, Basili S, De Matteis A, Cardarello CM, Di Franco M, et al. Morphologic left ventricular patterns and prevalence of highgrade ventricular arrhythmias in the normotensive and hypertensive elderly. Adv Ther 2000; 17:222–229. doi: 10.1007/bf02853161 11186142

8. Senges JC, Becker R, Schreiner KD, Bauer A, Weretka S, Siegler K et al. Variability of Holter electrocardiographic findings in patients fulfilling the noninvasive MADIT criteria. Multicenter Automatic Defibrillator Implantation Trial. Pacing Clin Electrophysiol 2002; 25:183–190. doi: 10.1046/j.1460-9592.2002.00183.x 11915985

9. Engstrom G, Hedblad B, Janzon L, Juul-Moller S. Ventricular arrhythmias during 24-h ambulatory ECG recording: incidence, risk factors and prognosis 240 in men with and without a history of cardiovascular disease. J Intern Med 1999; 246:363–372. doi: 10.1046/j.1365-2796.1999.00509.x 10583707

10. Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP et al. Echocardiographic Assessment of Valve Stenosis: EAE/ASE Recommendations for Clinical Practice. J Am Soc Echocardiogr 2009; 22:1–23. doi: 10.1016/j.echo.2008.11.029 19130998

11. Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, et al. Recommendations for Evaluation of the Severity of Native Valvular Regurgitation with Two-dimensional and Doppler Echocardiography. J Am Soc Echocardiogr 2003;16:777–802. doi: 10.1016/S0894-7317(03)00335-3 12835667

12. Katritsis DG, Camm AJ. Nonsustained ventricular tachycardia: where do we stand? Eur Heart J 2004; 25:1093–1099. doi: 10.1016/j.ehj.2004.03.022 15231366

13. Gabriels J, Wu M, Rosen L, Patel A. SC M, Goldner B. Clinical Significance of Nonsustained Ventricular Tachycardia on Stored Electrograms in Permanent Pacemaker Patients. Pacing Clin Electrophysiol. 2016 Dec;39(12):1335–1339 doi: 10.1111/pace.12968 27809339

14. Lin C-Y, Chang S-L, Chung F-P, Chen Y-Y, Lin Y-J, Lo L-W, et al. (2016) Long-Term Outcome of Non-Sustained Ventricular Tachycardia in Structurally Normal Hearts. PLoS ONE 11(8): e0160181. doi: 10.1371/journal.pone.0160181 27548469

15. Seth N, Kaplan R, Bustamante E, Kulkarni C, Subacius H, Rosenthal JE, et al. Clinical Significance of Nonsustained Ventricular Tachycardia on Routine Monitoring of Pacemaker Patients. Pacing Clin Electrophysiol. 2015 Aug;38(8):980–8. doi: 10.1111/pace.12632 25790151

16. Haqeel AJ, Sajeel AM, Gierula J, Paton MF, Lowry JE, Cubbon J, et al. Prognostic Significance mof Incidental Nonsustained Ventricular Tachycardia Detected on Pacemaker Interrogation Am J Cardiol 2019;123:409–413 doi: 10.1016/j.amjcard.2018.10.040 30473328


Článek vyšel v časopise

PLOS One


2019 Číslo 11