Futyma Piotr, Santangeli Pasquale, Zarębski Łukasz, Wrzos Aleksandra, Sander Jarosław, Futyma Marian, Marchlinski Francis E, Kułakowski Piotr
St. Joseph's Heart Rhythm Center Rzeszów Poland.
Medical College University of Rzeszów Rzeszów Poland.
J Arrhythm. 2024 Mar 15;40(3):578-584. doi: 10.1002/joa3.13017. eCollection 2024 Jun.
Implantable cardioverter-defibrillator (ICD) offers an opportunity to study inducibility of ventricular tachycardia (VT) or ventricular fibrillation (VF) by performing noninvasive programmed ventricular stimulation (NIPS). Whether NIPS can predict future arrhythmic events or mortality in patients with primary prevention ICD, has not yet been examined.
From the NIPS-ICD study (ClinicalTrials ID: NCT02373306) 41 consecutive patients (34 males, age 64 ± 11 years, 76% ischemic cardiomyopathy [ICM]) had ICD for primary prevention indication. Patients underwent NIPS using a standardized protocol of up to three premature extrastimuli at 600, 500 and 400 ms drive cycle lengths. NIPS was classified as positive if sustained VT or VF was induced. The study endpoint was occurrence of sustained VT/VF during the follow-up.
At baseline NIPS, VT/VF was induced in 8 (20%) ICM patients. During the 5-year follow-up, the VT/VF occurred in 7 (17%) patients, all with ICM. The difference between NIPS-inducible versus NIPS-noninducible patients regarding VT/VF occurrence did not meet statistical significance (38% vs. 12%, log rank test = .11). After a 5-year follow-up, the mortality rate was significantly higher in patients who had VT/VF induced at NIPS versus no VT/VF at NIPS (38% vs. 12%, = .043). The occurrence of a composite endpoint consisting of VT/VF recurrence or death in patients with ICM was also most frequent in the NIPS-inducible group (75% vs. 35%, = .037).
Inducibility of VT/VF during NIPS in ICM patients with primary prevention ICD is associated with higher mortality and higher incidence of composite endpoint consisting of death or VT/VF during a long-term observation.
植入式心脏复律除颤器（ICD）为通过进行无创程控心室刺激（NIPS）来研究室性心动过速（VT）或心室颤动（VF）的诱发情况提供了机会。NIPS能否预测一级预防ICD患者未来的心律失常事件或死亡率，尚未得到研究。
从NIPS-ICD研究（临床试验编号：NCT02373306）中选取41例连续患者（34例男性，年龄64±11岁，76%为缺血性心肌病[ICM]），这些患者因一级预防指征植入了ICD。患者采用标准化方案进行NIPS，在600、500和400毫秒的驱动周期长度下给予最多三次早搏刺激。如果诱发了持续性VT或VF，则NIPS分类为阳性。研究终点是随访期间持续性VT/VF的发生情况。
在基线NIPS时，8例（20%）ICM患者诱发了VT/VF。在5年随访期间，7例（17%）患者发生了VT/VF，均为ICM患者。NIPS可诱发与不可诱发患者在VT/VF发生方面的差异无统计学意义（38%对12%，对数秩检验=0.11）。经过5年随访，NIPS时诱发VT/VF的患者死亡率显著高于未诱发VT/VF的患者（38%对12%，P=0.043）。ICM患者中由VT/VF复发或死亡组成的复合终点的发生在NIPS可诱发组中也最为常见（75%对35%，P=0.037）。
在有一级预防ICD的ICM患者中，NIPS期间VT/VF的可诱发性与长期观察期间较高的死亡率以及由死亡或VT/VF组成的复合终点的较高发生率相关。
