Programmed ventricular stimulation in patients with idiopathic dilated cardiomyopathy and syncope receiving implantable cardioverter-defibrillators: a case series and a systematic review of the literature.
BACKGROUND
The role of programmed ventricular stimulation (PVS) in patients with idiopathic dilated cardiomyopathy (DCM) and syncope receiving implantable cardioverter-defibrillators (ICD) remains controversial.


RESULTS
Between 1994 and July 2002, 20 patients with DCM and syncope underwent PVS and ICD implantation at the Onassis Cardiac Surgery Center or the Alexandra General Hospital. At PVS 10 patients had inducible sustained monomorphic ventricular tachycardia (SMVT), 3 patients had inducible sustained polymorphic ventricular tachycardia or ventricular fibrillation, and 7 patients had no inducible arrhythmia. The latter 7 patients received an ICD because of clinical occurrence of ventricular tachycardia (n=5) or fibrillation (n=2). Mean age was 55+/-14 years; 80% were men. During a mean follow-up of 2.8+/-2.3 years, 12 of the 20 patients received an appropriate shock. The incidence of appropriate shocks at 1 and 3 years was 69% and 84% in the inducible SMVT group, and 56% and 67% in the group without inducible SMVT (p=0.93, log rank test). Overall survival was similar in both groups (p=0.53). In a systematic review of the published literature 18 of 75 (24%) patients with DCM, syncope and a negative PVS had an appropriate ICD shock after a mean follow-up of 27 months.


CONCLUSIONS
PVS has a limited role in risk stratification of patients with DCM and syncope.
Brilakis
Emmanouil S
ES
Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, 200 First street SW, Rochester, MN 55905, USA. brilakis.emmanouil@mayo.edu
Friedman
Paul A
PA
Maounis
Themos N
TN
Rokas
Stylianos G
SG
Shen
Win-Kuang
WK
Stamatelopoulos
Stamatios F
SF
Cokkinos
Dennis V
DV
D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000628:therapy; D002311:Cardiomyopathy, Dilated / Q000401:mortality / Q000628:therapy*; D017147:Defibrillators, Implantable; D015716:Electrocardiography, Ambulatory; D022062:Electrophysiologic Techniques, Cardiac; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D018570:Risk Assessment; D013575:Syncope / Q000628:therapy*; D017180:Tachycardia, Ventricular