title: Induction of ventricular fibrillation rather than ventricular tachycardia predicts tachyarrhythmia recurrences in patients with idiopathic dilated cardiomyopathy and implantable cardioverter defibrillator for secondary prophylaxis.
abstract: OBJECTIVE
  We sought to investigate the association of inducibility of polymorphic ventricular tachycardia or ventricular fibrillation (PVT/VF) or sustained monomorphic ventricular tachycardia (SMVT) at standardized programmed ventricular stimulation (PVS) with the long-term likelihood of sudden death and/or fast VT in a large cohort of patients with idiopathic non-ischaemic dilated cardiomyopathy (DCM) and implantable cardioverter defibrillator (ICD) for secondary prophylaxis.
  
  
  RESULTS
  Between 1994 and 2007, 160 consecutive patients with DCM and spontaneous sustained VT/VF or cardiac arrest underwent PVS prior to ICD implantation. Outcome data, particularly probability of survival without (sudden) death or appropriate ICD therapies for fast VT, were assessed during long-term follow-up. PVT/VF was induced in 50 (31%) and SMVT in 30 (19%) patients. During a mean follow-up of 53 +/- 15 months, we observed 19/50 (38%), 10/30 (33%), and 14/80 (18%) deaths in the PVT/VF, SMVT, and non-inducible group, respectively. These deaths were sudden in 7/50 (14%), 2/30 (7%), and 0/80 (0%) of patients, respectively. At least one fast VT was treated by the ICD in 26/50 (52%), 6/30 (20%), and 22/80 (28%) patients, respectively. PVT/VF but not SMVT-inducible patients had a significantly worse overall survival (log-rank P = 0.013), survival without sudden cardiac death (P < 0.01), or survival without fast VT (P < 0.01) according to Kaplan-Meier method than non-inducible patients. Additionally, survival free of fast VT was significantly worse in PVT/VF vs. SMVT-inducible patients (P < 0.01).
  
  
  CONCLUSIONS
  Inducibility of PVT/VF is a much stronger predictor of recurrences of fast VT as opposed to SMVT induction in DCM patients with ICD for secondary prevention.
authors.affiliation: Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Medizinische Klinik mit Schwerpunkt Kardiologie, Augustenburger Platz 1, D-13553 Berlin, Germany. sascha.rolf@charite.de
authors.forename: Sascha
authors.initials: S
authors.lastname: Rolf
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Haverkamp
authors.forename: Martin
authors.initials: M
authors.lastname: Borggrefe
authors.forename: Guenter
authors.initials: G
authors.lastname: Breithardt
authors.forename: Dirk
authors.initials: D
authors.lastname: Bocker
mesh_terms: D009202:Cardiomyopathies / Q000150:complications* / Q000517:prevention & control*; D002986:Clinical Trials as Topic; D016757:Death, Sudden, Cardiac / Q000209:etiology* / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004558:Electric Stimulation / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000517:prevention & control; D055502:Secondary Prevention; D017180:Tachycardia, Ventricular / Q000175:diagnosis*; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000175:diagnosis*