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CLINICAL STUDIES

Clusters of ventricular tachycardias signify impaired survival in patients with idiopathic dilated cardiomyopathy and implantable cardioverter defibrillators

^a Department of Cardiology, St. Georg’s Hospital, Hamburg, Germany
^b Department of Cardiology, Angiology and Institute for Research in Arteriosclerosis, Westfälische Wilhelms-University, Münster, Germany

Manuscript received February 3, 1999; revised manuscript received January 20, 2000, accepted March 29, 2000.

Reprint requests and correspondence: Dr. Dietmar Bänsch, St. Georg Hospital, Lohmühlenstr. 5 D-20099 Hamburg, Germany
Bae151162{at}aol.com

OBJECTIVES

This retrospective study was undertaken to provide data on occurrence, significance and therapy of ventricular tachyarrhythmia (VT) clusters (VTCs) in patients with dilated cardiomyopathy (DCM) and implantable cardioverter defibrillators (ICDs).

BACKGROUND

Data on the clinical significance of VTCs are lacking in patients with DCM and ICDs.

METHODS

Baseline characteristics of 106 consecutive patients with DCM and ICDs were prospectively collected, and chart reviews and episode data retrospectively analyzed. A VTC was defined as 3 sustained VTs/24 h.

RESULTS

During a mean follow-up of 33 ± 23 months, 73 patients (68.9%) had recurrent VT or ventricular fibrillation (VF), 43 patients (40.6%) suffered only single VTs and 30 patients (28.3%) experienced 52 clusters of VTs. Actuarial survival free of VT or VF was 44.6%, 33.0% and 26.5%, and survival free of VTC was 77.3%, 72.2% and 67.1% after one, two and three years, respectively. Independent predictors of VT clusters were heart failure before ICD implantation (p = 0.033), presenting monomorphic VT (p = 0.044), EF <0.40 (p = 0.014) and inducible mVT, especially with right bundle branch block and superior axis configuration (p < 0.001). Survival free of recurrent VTCs was 50.8%, 38.1% and 19.0% after one, two and three years, respectively. Once a VTC had occurred, only 56.7%, 46.4%, 30.9% and 15.5% of patients survived and were not transplanted after one, two, three and four years, respectively. Survival was even more reduced if a VTC was associated with cardiac decompensation: 65.6% and 21.9% after one and two years, respectively.

CONCLUSIONS

Despite antiarrhythmic intervention, clusters of VTs occur and recur frequently in patients with DCM. They signify impaired survival, especially if they are associated with cardiac decompensation, and may be a harbinger of progressive myocardial deterioration rather than a primarily arrhythmic problem. The benefit of ICD therapy may therefore be low in these patients.

Abbreviations and Acronyms   CAD = coronary artery disease   DCM = dilated cardiomyopathy   EF = ejection fraction   EPS = electrophysiologic study   ICD = implantable cardioverter defibrillator   PVS = programmed ventricular stimulation   VF = ventricular fibrillation   VT = ventricular tachycardia   VTC = ventricular tachycardia cluster

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