(Circulation. 2000;101:40.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Ambulatory Ventricular Arrhythmias in Patients With Heart Failure Do Not Specifically Predict an Increased Risk of Sudden Death
From the Cardiovascular Research Institute and Department of Medicine, University of California, and the Section of Cardiology, Department of Veterans Affairs Medical Center, San Francisco, Calif (J.R.T., B.M.M.); the Biostatistics Center, University of Wisconsin, Madison, Wis (M.J., S.A.); Division of Cardiology, Mt Sinai Medical Center, New York, NY (M.L.K.); Section of Cardiology, Department of Veterans Affairs Medical Center, Dallas, Tex (E.J.E.); Cardiology Division, The Cleveland Clinic Foundation, Cleveland, Ohio (G.F.); and Cardiology Division, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY (M.P.)
Correspondence to Barry M. Massie, MD, Section of Cardiology (111C), San Francisco Veterans Affairs Medical Center, 4150 Clement St, San Francisco, CA 94121.
Background—Ventricular arrhythmias are a frequent finding in congestive heart failure (CHF) patients and a cause of concern for physicians caring for them. Previous studies have reached conflicting conclusions regarding the importance of ventricular arrhythmias as predictors of sudden death in patients with CHF. This study examined the independent predictive value of ventricular arrhythmias for sudden death and all-cause mortality in PROMISE (Prospective Randomized Milrinone Survival Evaluation).
Methods and Results—Ventricular arrhythmias
were analyzed and quantified by use of prespecified criteria on
baseline ambulatory ECGs from 1080 patients with New York Heart
Association (NYHA) class III/IV symptoms and a left
ventricular ejection fraction 
35% enrolled in PROMISE.
The relationship of ventricular arrhythmias and
other clinical parameters to overall mortality and sudden
death classified by an independent, blinded mortality committee was
determined. There were 290 deaths, of which 139 were classified as
sudden. Of the several measures of ventricular ectopy that
were univariate predictors, the frequency of nonsustained
ventricular tachycardia (NSVT) was the most
powerful predictor and remained a significant independent predictor
when included with other clinical variables in
multivariate models of both sudden death mortality and
non–sudden death mortality. However, multiple logistic
analysis with models including the clinical variables with
and without the NSVT variable demonstrated that the frequency of
NSVT did not add significant information beyond the clinical
variables.
Conclusions—This study demonstrates that ventricular arrhythmias do not specifically predict sudden death in patients with moderate-to-severe heart failure. Thus, the finding of asymptomatic NSVT on ambulatory ECG does not identify specific candidates for antiarrhythmic or device therapy.
Key Words: arrhythmia • death, sudden • heart failure • inotropic agents • prognosis
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