title: Predictive value of programmed ventricular stimulation in patients with ischaemic cardiomyopathy: implications for the selection of candidates for an implantable defibrillator.
abstract: OBJECTIVE
  The present study assessed the role of programmed ventricular stimulation (PVS) in risk stratification of patients with ischaemic cardiomyopathy (ICM), candidates for implantable cardioverter-defibrillator (ICD).
  
  
  RESULTS
  Consecutive patients with ICM and LVEF < or = 40% (n = 106, age 61 +/- 7 years, LVEF 27 +/- 7%) underwent PVS. This was considered positive in case of inducibility of monomorphic ventricular tachycardia (VT) with < or =3 extrastimuli; polymorphic VT, ventricular fibrillation (VF), and fast monomorphic VT (CL < or = 230 ms) with < or =2 extrastimuli. Primary end-point was the combination of arrhythmic death and VF requiring ICD shock. Forty-nine patients (46%) were inducible at PVS; 74 (70%) were implanted with ICD. During a 24-month follow-up, the primary end-point occurred more frequently in positive PVS patients among the overall population, among patients with LVEF < or = 30% (n = 80) and among patients with an ICD. The negative predictive value of PVS was 96% in each group. In the overall population, both PVS (HR 7.32, 95% CI 1.6-32) and LVEF (HR 4.59, 95% CI 1.6-13) predicted the primary end-point.
  
  
  CONCLUSIONS
  PVS may still have a role in predicting the arrhythmic risk in patients with ICM. A negative PVS identifies a subgroup with a very low risk of arrhythmic events even in patients with LVEF < or = 30%.
authors.affiliation: Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy. g.deferrari@smatteo.pv.it
authors.forename: Gaetano M
authors.initials: GM
authors.lastname: De Ferrari
authors.forename: Roberto
authors.initials: R
authors.lastname: Rordorf
authors.forename: Folco
authors.initials: F
authors.lastname: Frattini
authors.forename: Barbara
authors.initials: B
authors.lastname: Petracci
authors.forename: Paolo
authors.initials: P
authors.lastname: De Filippo
authors.forename: Maurizio
authors.initials: M
authors.lastname: Landolina
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable; D004599:Electric Stimulation Therapy / Q000379:methods*; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D018579:Patient Selection; D011237:Predictive Value of Tests; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology; D014693:Ventricular Fibrillation / Q000209:etiology / Q000503:physiopathology / Q000628:therapy