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Prognostic Significance of Incidental Nonsustained Ventricular Tachycardia Detected on Pacemaker Interrogation

Published:November 06, 2018DOI:https://doi.org/10.1016/j.amjcard.2018.10.040
      Symptomatic sustained ventricular tachycardia is a life threatening arrhythmia requiring prompt treatment. However, the risk associated with asymptomatic nonsustained ventricular tachycardia (NSVT) detected on routine permanent pacemaker (PPM) interrogation in patients with known cardiac conduction disease is unknown. Our aim is to determine if asymptomatic NSVT detected on PPM interrogation is associated with increased mortality. As part of a prospective observational cohort study, 582 patients with long-term pacemakers were recruited at a tertiary cardiac centre, and followed for 4 ± 1.96 years (mean ± standard deviation). At each subsequent pacemaker check, any symptoms and ventricular high-rate episodes were recorded. We excluded 17 patients due to incomplete data. In the remaining 565 patients (57% male, age 74.5 ± 19.2 years, left ventricular ejection fraction 50.0 ± 11.3%), NSVT was found in 125 (22.1%) patients with a higher prevalence in males (65% vs 54%; p = 0.033). Those with NSVT were more likely to have had coronary artery disease (p = 0) or previous myocardial infarction (p = 0.015). After correction for baseline variables, NSVT had no impact on survival (n = 52 [42%] vs n = 162 [37%]; log-rank p = 0.331, hazard ratio: 0.927, 95% confidence interval: 0.678 to 1.268, p = 0.697). In conclusion, asymptomatic NSVT identified on PPM interrogation does not appear to be associated with increased mortality, thus whether treatment to suppress this arrhythmia is of benefit remains unproven.
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      References

        • Katritsis D.G.
        • Zareba W.
        • Camm A.J.
        Nonsustained ventricular tachycardia.
        J Am Coll Cardiol. 2012; 60: 1993-2004
        • Mitra R.L.
        • Buxton A.E.
        The clinical significance of nonsustained ventricular tachycardia.
        J Cardiovasc Electrophysiol. 1993; 4: 490-496
        • Crossley G.H.
        • Chen J.
        • Choucair W.
        • Cohen T.J.
        • Gohn D.C.
        • Johnson W.B.
        • Kennedy E.E.
        • Mongeon L.R.
        • Serwer G.A.
        • Qiao H.
        • Wilkoff B.L.
        • PREFER Study Investigators
        Clinical benefits of remote versus transtelephonic monitoring of implanted pacemakers.
        J Am Coll Cardiol. 2009; 54: 2012-2019
        • Priori S.G.
        • Blomström-Lundqvist C.
        • Mazzanti A.
        • Blom N.
        • Borggrefe M.
        • Camm J.
        • Elliott P.M.
        • Fitzsimons D.
        • Hatala R.
        • Hindricks G.
        • Kirchhof P.
        • Kjeldsen K.
        • Kuck K.H.
        • Hernandez-Madrid A.
        • Nikolaou N.
        • Norekvål T.M.
        • Spaulding C.
        • Van Veldhuisen D.J.
        2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: the Task Force for the Management of Patients with ventricular arrhythmias and the prevention of sudden cardiac death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC).
        Eur Heart J. 2015; 36: 2793-2867
        • Engstrom G.
        • Hedblad B.
        • Janzon L.
        • Juul-Moller S.
        Ventricular arrhythmias during 24-h ambulatory ECG recording: incidence, risk factors and prognosis in men with and without a history of cardiovascular disease.
        J Intern Med. 1999; 246: 363-372
        • Buxton A.E.
        • Calkins H.
        • Callans D.J.
        • DiMarco J.P.
        • Fisher J.D.
        • Greene H.L.
        • Haines D.E.
        • Hayes D.L.
        • Heidenreich P.A.
        • Miller J.M.
        • Poppas A.
        • Prystowsky E.N.
        • Schoenfeld M.H.
        • Zimetbaum P.J.
        • Goff D.C.
        • Grover F.L.
        • Malenka D.J.
        • Peterson E.D.
        • Radford M.J.
        • Redberg R.F.
        • American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (ACC/AHA/HRS Writing Committee to Develop Data Standards on Electrophysiology)
        ACC/AHA/HRS 2006 key data elements and definitions for electrophysiological studies and procedures: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (ACC/AHA/HRS Writing Committee to Develop D.
        J Am Coll Cardiol. 2006; 48: 2360-2396
        • Allen M.S.
        • Abrich V.A.
        • Bibby P.S.
        • Fishman D.
        • Shen W.
        • Sorajja D.
        Prevalence and prognostic significance of nonsustained ventricular tachycardia in patients with a left ventricular ejection fraction from 35% to 50%.
        Am J Cardiol. 2018; 121: 330-335
        • Marine J.E.
        • Shetty V.
        • Chow G V.
        • Wright J.G.
        • Gerstenblith G.
        • Najjar S.S.
        • Lakatta E.G.
        • Fleg J.L.
        Prevalence and prognostic significance of exercise-induced nonsustained ventricular tachycardia in asymptomatic volunteers: BLSA (Baltimore Longitudinal Study of Aging).
        J Am Coll Cardiol. 2013; 62: 595-600
        • Seth N.
        • Kaplan R.
        • Bustamante E.
        • Kulkarni C.
        • Subacius H.
        • Rosenthal J.E.
        • Passman R.
        Clinical significance of nonsustained ventricular tachycardia on routine monitoring of pacemaker patients.
        Pacing Clin Electrophysiol. 2015; 38: 980-988
        • Gabriels J.
        • Wu M.
        • Rosen L.
        • Patel A.
        • Goldner B.
        Clinical significance of nonsustained ventricular tachycardia on stored electrograms in permanent pacemaker patients.
        Pacing Clin Electrophysiol. 2016 Dec; 39: 1335-1339
        • Senges J.C.
        • Becker R.
        • Schreiner K.D.
        • Bauer A.
        • Weretka S.
        • Siegler K.
        • Kuebler W.
        • Schoels W.
        Variability of Holter electrocardiographic findings in patients fulfilling the noninvasive MADIT criteria. Multicenter Automatic Defibrillator Implantation Trial.
        Pacing Clin Electrophysiol. 2002; 25: 183-190
        • Callans D.J.
        Evaluation and Treatment of arrhythmias in heart failure.
        in: Jessup M.L. Loh E. Heart Failure. Contemporary Cardiology. Humana Press, Totowa, NJ2003: 253-269
        • Faber T.S.
        • Gradinger R.
        • Treusch S.
        • Morkel C.
        • Brachmann J.
        • Bode C.
        • Zehender M.
        • EVENTS Investigators
        Incidence of ventricular tachyarrhythmias during permanent pacemaker therapy in low-risk patients results from the German multicentre EVENTS study.
        Eur Heart J. 2007; 28: 2238-2242
        • Fleg J.L.
        • Kennedy H.L.
        Long-term prognostic significance of ambulatory electrocardiographic findings in apparently healthy subjects ≥60 years of age.
        Am J Cardiol. 1992; 70: 748-751
        • Adabag A.S.
        • Casey S.A.
        • Kuskowski M.A.
        • Zenovich A.G.
        • Maron B.J.
        Spectrum and prognostic significance of arrhythmias on ambulatory Holter electrocardiogram in hypertrophic cardiomyopathy.
        J Am Coll Cardiol. 2005; 45: 697-704
        • Monserrat L.
        • Elliott P.M.
        • Gimeno J.R.
        • Sharma S.
        • Penas-Lado M.
        • McKenna W.J.
        Non-sustained ventricular tachycardia in hypertrophic cardiomyopathy: an independent marker of sudden death risk in young patients.
        J Am Coll Cardiol. 2003; 42: 873-879
        • Santini M.
        • Russo M.
        • Botto G.
        • Lunati M.
        • Proclemer A.
        • Schmidt B.
        • Erdogan A.
        • Helmling E.
        • Rauhe W.
        • Desaga M.
        • Santi E.
        • Messier M.
        • Boriani G.
        Clinical and arrhythmic outcomes after implantation of a defibrillator for primary prevention of sudden death in patients with post-myocardial infarction cardiomyopathy: the survey to Evaluate Arrhythmia Rate in High-risk MI patients (SEARCH-MI).
        Europace. 2009; 11: 476-482
        • Holmes J.
        • Kubo S.H.
        • Cody R.J.
        • Kligfield P.
        Arrhythmias in ischemic and nonischemic dilated cardiomyopathy: prediction of mortality by ambulatory electrocardiography.
        Am J Cardiol. 1985; 55: 146-151
        • Pelliccia F.
        • Gallo P.
        • Cianfrocca C.
        • d'Amati G.
        • Bernucci P.
        • Reale A.
        Relation of complex ventricular arrhythmias to presenting features and prognosis in dilated cardiomyopathy.
        Int J Cardiol. 1990; 29: 47-54
        • The Cardiac Arrhythmia Suppression Trial (CAST) Investigators
        The preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction.
        N Engl J Med. 1989; 321: 406-412
        • Friedman L.M.
        • Byington R.P.
        • Capone R.J.
        • Furberg C.D.
        • Goldstein S.
        • Lichstein E.
        Effect of propranolol in patients with myocardial infarction and ventricular arrhythmia.
        J Am Coll Cardiol. 1986; 7: 1-8