Risk stratification for arrhythmic events in patients with nonischemic dilated cardiomyopathy and nonsustained ventricular tachycardia: role of programmed ventricular stimulation and the signal-averaged electrocardiogram

Department of Medicine, State University of New York Health Science Center at Brooklyn 11203.

OBJECTIVES. This study investigated prediction of arrhythmic events by the signal-averaged electrocardiogram (ECG) and programmed stimulation in patients with nonischemic dilated cardiomyopathy. BACKGROUND. Risk stratification in patients with nonischemic dilated cardiomyopathy remains controversial. METHODS. Eighty patients with nonischemic dilated cardiomyopathy and spontaneous nonsustained ventricular tachycardia underwent signal-averaged electrocardiography (both time-domain and spectral turbulence analysis) and programmed stimulation. All patients were followed up for a mean of 22 +/- 26 months. RESULTS. Sustained monomorphic ventricular tachycardia was induced in 10 patients (13%), who all received amiodarone. The remaining 70 patients were followed up without antiarrhythmic therapy. Of the 80 patients, 15% had abnormal findings on the time-domain signal-averaged ECG, and 39% had abnormal findings on spectral turbulence analysis. Time-domain signal-averaged electrocardiography had a better predictive accuracy for induced ventricular tachycardia than spectral turbulence analysis (88% vs. 66%, p < 0.01). During follow-up, there were 9 arrhythmic events (5 sudden deaths, 4 spontaneous ventricular tachycardia/fibrillation) and 10 nonsudden cardiac deaths. Cox regression analysis showed that no variables predicted arrhythmic events or total cardiac deaths. The 2-year actuarial survival free of arrhythmic events was similar in patients with or without abnormal findings on the signal-averaged ECG or induced ventricular tachycardia. CONCLUSIONS. In patients with nonischemic dilated cardiomyopathy, 1) there is a strong correlation between abnormal findings on the time-domain signal-averaged ECG and induced ventricular tachycardia, but both findings are uncommon; and 2) normal findings on the signal-averaged ECG, as well as failure to induce ventricular tachycardia, do not imply a benign outcome.

This article has been cited by other articles:

				J. J. Goldberger, M. E. Cain, S. H. Hohnloser, A. H. Kadish, B. P. Knight, M. S. Lauer, B. J. Maron, R. L. Page, R. S. Passman, D. Siscovick, et al. American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific Statement on Noninvasive Risk Stratification Techniques for Identifying Patients at Risk for Sudden Cardiac Death: A Scientific Statement From the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention J. Am. Coll. Cardiol., August 25, 2008; (2008) j.jacc.2008.05.003v1. [Full Text] [PDF]

				J. A. Salerno-Uriarte, G. M. De Ferrari, C. Klersy, R. F.E. Pedretti, M. Tritto, L. Sallusti, L. Libero, G. Pettinati, G. Molon, A. Curnis, et al. Prognostic Value of T-Wave Alternans in Patients With Heart Failure Due to Nonischemic Cardiomyopathy: Results of the ALPHA Study J. Am. Coll. Cardiol., November 6, 2007; 50(19): 1896 - 1904. [Abstract] [Full Text] [PDF]

				K. A. Ellenbogen, J. H. Levine, R. D. Berger, J. P. Daubert, S. L. Winters, E. Greenstein, A. Shalaby, A. Schaechter, H. Subacius, A. Kadish, et al. Are Implantable Cardioverter Defibrillator Shocks a Surrogate for Sudden Cardiac Death in Patients With Nonischemic Cardiomyopathy? Circulation, February 14, 2006; 113(6): 776 - 782. [Abstract] [Full Text] [PDF]

				W. Grimm, M. Christ, J. Bach, H.-H. Muller, and B. Maisch Noninvasive Arrhythmia Risk Stratification in Idiopathic Dilated Cardiomyopathy: Results of the Marburg Cardiomyopathy Study Circulation, December 9, 2003; 108(23): 2883 - 2891. [Abstract] [Full Text] [PDF]

				R. C. Saumarez, L. Chojnowska, R. Derksen, M. Pytkowski, M. Sterlinski, C. L.-H. Huang, N. Sadoul, R. N.W. Hauer, W. Ruzyllo, and A. A. Grace Sudden Death in Noncoronary Heart Disease Is Associated With Delayed Paced Ventricular Activation Circulation, May 27, 2003; 107(20): 2595 - 2600. [Abstract] [Full Text] [PDF]

				W. Grimm, J.u. Hoffmann, H.-H. Muller, and B. Maisch Implantable defibrillator event rates in patients with idiopathic dilated cardiomyopathy, nonsustained ventricular tachycardia on Holter and a left ventricular ejection fraction below 30% J. Am. Coll. Cardiol., March 6, 2002; 39(5): 780 - 787. [Abstract] [Full Text] [PDF]

				A. E. Buxton, K. L. Lee, L. DiCarlo, M. R. Gold, G. S. Greer, E. N. Prystowsky, M. F. O'Toole, A. Tang, J. D. Fisher, J. Coromilas, et al. Electrophysiologic Testing to Identify Patients with Coronary Artery Disease Who Are at Risk for Sudden Death N. Engl. J. Med., June 29, 2000; 342(26): 1937 - 1945. [Abstract] [Full Text] [PDF]

				S.H. Hohnloser Electrocardiographic risk stratification in dilative cardiomyopathy: an unfulfilled promise Eur. Heart J., June 2, 2000; 21(12): 953 - 954. [PDF]

				K. Adachi, Y. Ohnishi, T. Shima, K. Yamashiro, A. Takei, N. Tamura, and M. Yokoyama Determinant of microvolt-level T-wave alternans in patients with dilated cardiomyopathy J. Am. Coll. Cardiol., August 1, 1999; 34(2): 374 - 380. [Abstract] [Full Text] [PDF]

				W. Grimm, J.u. Hoffmann, V. Menz, K. Luck, and B. Maisch Programmed ventricular stimulation for arrhythmia risk prediction in patients with idiopathic dilated cardiomyopathy and nonsustained ventricular tachycardia J. Am. Coll. Cardiol., September 1, 1998; 32(3): 739 - 745. [Abstract] [Full Text] [PDF]

				T Yamada, M Fukunami, T Shimonagata, K Kumagai, J Kim, S Sanada, H Ogita, M Hori, and N Hoki Prediction of the effectiveness of long term beta  blocker treatment for dilated cardiomyopathy by signal averaged electrocardiography Heart, March 1, 1998; 79(3): 256 - 261. [Abstract] [Full Text]

				A. Martinez-Rubio, Y. Schwammenthal, E. Schwammenthal, M. Block, L. Reinhardt, A. Garcia-Alberola, G. Sierra, M. Shenasa, W. Haverkamp, H. H. Scheld, et al. Patients With Valvular Heart Disease Presenting With Sustained Ventricular Tachyarrhythmias or Syncope : Results of Programmed Ventricular Stimulation and Long-term Follow-up Circulation, July 15, 1997; 96(2): 500 - 508. [Abstract] [Full Text]