(Circulation. 1996;94:3198-3203.)
© 1996 American Heart Association, Inc.
Articles |
Nonsustained Ventricular Tachycardia in Severe Heart Failure
Independent Marker of Increased Mortality due to Sudden Death
Correspondence to Dr Hernan C. Doval, Malvinas Argentinas 740, Capital Federal, Argentina, CP 1406.
Background The goal of the study was to determine the prognostic value of nonsustained ventricular tachycardia (NSVT) in total mortality in severe congestive heart failure (CHF) and in death modes. NSVT is associated with an increased mortality in CHF. However, the predictive value of NSVT as a marker for sudden death or death due to progressive heart failure has not been determined.
Methods and Results Five hundred sixteen patients from the GESICA trial (33.4% with NSVT) were initially studied with the results of 24-hour Holter and 2 years of follow-up. Within 2 years, 87 of 173 patients (50.3%) with NSVT and 106 of 343 patients (30.9%) without NSVT died. Relative risk (RR) was 1.69 (95% confidence interval [CI], 1.27 to 2.24; P<.0002), and Cox proportional hazard analysis was 1.62 (95% CI, 1.22 to 2.16; P<.001). Sudden death increased from 8.7% (30 of 343) to 23.7% (41 of 173) in patients with NSVT (RR, 2.77; 95% CI, 1.78 to 4.44; P<.001). Progressive heart failure death was also increased from 17.5% (60 of 343) to 20.8% (36 of 173) (P=.22). Quantitative analysis of 24-hour Holter (first 295 patients) demonstrated that couplets had a similar RR to that of NSVT for both total mortality (RR, 1.81; 95% CI, 1.22 to 2.66; P<.002) and sudden death (RR, 3.37; 95% CI, 1.57 to 7.25; P<.0005). Couplets and/or NSVT (ventricular repetitive beats) were even more predictive for sudden death (RR, 10.1; 95% CI, 1.91 to 52.7; P<.01).
Conclusions In patients with CHF, NSVT is an independent marker for increased overall mortality rate and sudden death. The absence of NSVT and ventricular repetitive beats in a 24-hour Holter indicates a low probability of sudden death.
Key Words: heart failure • arrhythmias • death, sudden
This article has been cited by other articles:
 |
|
 |
|
  S. Boveda, E. Marijon, S. Jacob, P. Defaye, J. B. Winter, A. Bulava, D. Gras, J. P. Albenque, N. Combes, D. Pavin, et al. Incidence and prognostic significance of sustained ventricular tachycardias in heart failure patients implanted with biventricular pacemakers without a back-up defibrillator: results from the prospective, multicentre, Mona Lisa cohort study Eur. Heart J., May 2, 2009; 30(10): 1237 - 1244. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. R. de Sousa, C. A. Morillo, F. T. Rabelo, A. M. N. Filho, and A. L.P. Ribeiro Non-sustained ventricular tachycardia as a predictor of sudden cardiac death in patients with left ventricular dysfunction: A meta-analysis Eur J Heart Fail, October 1, 2008; 10(10): 1007 - 1014. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. J. Goldberger, M. E. Cain, S. H. Hohnloser, A. H. Kadish, B. P. Knight, M. S. Lauer, B. J. Maron, R. L. Page, R. S. Passman, D. Siscovick, et al. American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific Statement on Noninvasive Risk Stratification Techniques for Identifying Patients at Risk for Sudden Cardiac Death: A Scientific Statement From the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention J. Am. Coll. Cardiol., September 30, 2008; 52(14): 1179 - 1199. [Full Text] [PDF]
|
|
|
|
 |
|
 J. J. Goldberger, M. E. Cain, S. H. Hohnloser, A. H. Kadish, B. P. Knight, M. S. Lauer, B. J. Maron, R. L. Page, R. S. Passman, D. Siscovick, et al. American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific Statement on Noninvasive Risk Stratification Techniques for Identifying Patients at Risk for Sudden Cardiac Death: A Scientific Statement From the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention Circulation, September 30, 2008; 118(14): 1497 - 1518. [Full Text] [PDF]
|
|
|
|
|
|
Developed in Collaboration With the European Heart, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) J. Am. Coll. Cardiol., September 5, 2006; 48(5): e247 - e346. [Full Text] [PDF]
|
|
|
|
 |
|
 Writing Committee Members, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society Europace, September 1, 2006; 8(9): 746 - 837. [Full Text] [PDF]
|
|
|
|
 |
|
 S. E. Shoaf, M. V. Elizari, Z. Wang, K. Sekar, L. R. Grinfeld, N. A. Barbagelata, J. Lerman, S. L. Bramer, J. Tronge, and C. Orlandi Tolvaptan Administration Does Not Affect Steady State Amiodarone Concentrations in Patients With Cardiac Arrhythmias Journal of Cardiovascular Pharmacology and Therapeutics, July 1, 2005; 10(3): 165 - 171. [Abstract] [PDF]
|
|
|
|
 |
|
 M T Kearney, K A A Fox, A J Lee, W P Brooksby, A M Shah, A Flapan, R J Prescott, R Andrews, P D Batin, D L Eckberg, et al. Predicting sudden death in patients with mild to moderate chronic heart failure Heart, October 1, 2004; 90(10): 1137 - 1143. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. G Katritsis and A.J. Camm Nonsustained ventricular tachycardia: where do we stand? Eur. Heart J., July 1, 2004; 25(13): 1093 - 1099. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Kadish, A. Dyer, J. P. Daubert, R. Quigg, N.A. M. Estes, K. P. Anderson, H. Calkins, D. Hoch, J. Goldberger, A. Shalaby, et al. Prophylactic Defibrillator Implantation in Patients with Nonischemic Dilated Cardiomyopathy N. Engl. J. Med., May 20, 2004; 350(21): 2151 - 2158. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. H. Hohnloser, T. Klingenheben, D. Bloomfield, O. Dabbous, and R. J. Cohen Usefulness of microvolt T-wave alternans for prediction of ventricular tachyarrhythmic events in patients with dilated cardiomyopathy: results from a prospective observational study J. Am. Coll. Cardiol., June 18, 2003; 41(12): 2220 - 2224. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. C. Deedwania The Key to Unraveling the Mystery of Mortality in Heart Failure: An Integrated Approach Circulation, April 8, 2003; 107(13): 1719 - 1721. [Full Text] [PDF]
|
|
|
|
|
|
R. Berger, M. Huelsman, K. Strecker, A. Bojic, P. Moser, B. Stanek, and R. Pacher B-Type Natriuretic Peptide Predicts Sudden Death in Patients With Chronic Heart Failure Circulation, May 21, 2002; 105(20): 2392 - 2397. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Grimm, J.u. Hoffmann, H.-H. Muller, and B. Maisch Implantable defibrillator event rates in patients with idiopathic dilated cardiomyopathy, nonsustained ventricular tachycardia on Holter and a left ventricular ejection fraction below 30% J. Am. Coll. Cardiol., March 6, 2002; 39(5): 780 - 787. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. V. Huikuri, A. Castellanos, and R. J. Myerburg Sudden Death Due to Cardiac Arrhythmias N. Engl. J. Med., November 15, 2001; 345(20): 1473 - 1482. [Full Text] [PDF]
|
|
|
|
|
|
Task Force for the Diagnosis and Treatment of Chro, W. J. Remme, and K. Swedberg Guidelines for the diagnosis and treatment of chronic heart failure Eur. Heart J., September 1, 2001; 22(17): 1527 - 1560. [PDF]
|
|
|
|
|
|
T. M. Ramahi, M. D. Longo, A. R. Cadariu, K. Rohlfs, S. A. Carolan, K. M. Engle, H. Samady, and F. J. T. Wackers Left ventricular inotropic reserve and right ventricular function predict increase of left ventricular ejection fraction after beta-blocker therapy in nonischemic cardiomyopathy J. Am. Coll. Cardiol., March 1, 2001; 37(3): 818 - 824. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Cice, E. Tagliamonte, L. Ferrara, and A. Iacono Efficacy of carvedilol on complex ventricular arrhythmias in dilated cardiomyopathy: double-blind, randomized, placebo-controlled study Eur. Heart J., August 1, 2000; 21(15): 1259 - 1264. [Abstract] [PDF]
|
|
|
|
 |
|
 A. D. Auerbach, M. B. Hamel, R. B. Davis, A. F. Connors Jr., C. Regueiro, N. Desbiens, L. Goldman, R. M. Califf, N. V. Dawson, N. Wenger, et al. Resource Use and Survival of Patients Hospitalized with Congestive Heart Failure: Differences in Care by Specialty of the Attending Physician Ann Intern Med, February 1, 2000; 132(3): 191 - 200. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. R. Teerlink, M. Jalaluddin, S. Anderson, M. L. Kukin, E. J. Eichhorn, G. Francis, M. Packer, and B. M. Massie Ambulatory Ventricular Arrhythmias in Patients With Heart Failure Do Not Specifically Predict an Increased Risk of Sudden Death Circulation, January 4, 2000; 101(1): 40 - 46. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P S Macdonald, A M Keogh, C Aboyoun, M Lund, R Amor, and D McCaffrey Impact of concurrent amiodarone treatment on the tolerability and efficacy of carvedilol in patients with chronic heart failure Heart, November 1, 1999; 82(5): 589 - 593. [Abstract] [Full Text]
|
|
|
|
|
|
M. H. Crawford, S. J. Bernstein, P. C. Deedwania, J. P. DiMarco, K. J. Ferrick, A. Garson Jr, L. A. Green, H. L. Greene, M. J. Silka, P. H. Stone, et al. ACC/AHA guidelines for ambulatory electrocardiography: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the Guidelines for Ambulatory Electrocardiography) developed in collaboration with the North American Society for Pacing and Electrophysiology J. Am. Coll. Cardiol., September 1, 1999; 34(3): 912 - 948. [Full Text] [PDF]
|
|
|
|
|
|
P. J. Zimetbaum and M. E. Josephson The Evolving Role of Ambulatory Arrhythmia Monitoring in General Clinical Practice Ann Intern Med, May 18, 1999; 130(10): 848 - 856. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Pogwizd, J. P. McKenzie, and M. E. Cain Mechanisms Underlying Spontaneous and Induced Ventricular Arrhythmias in Patients With Idiopathic Dilated Cardiomyopathy Circulation, December 1, 1998; 98(22): 2404 - 2414. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. P. Zipes and H. J. J. Wellens Sudden Cardiac Death Circulation, November 24, 1998; 98(21): 2334 - 2351. [Full Text] [PDF]
|
|
|
|
|
|
A. N. Cheema, K. Sheu, M. Parker, A. H. Kadish, and J. J. Goldberger Nonsustained Ventricular Tachycardia in the Setting of Acute Myocardial Infarction : Tachycardia Characteristics and Their Prognostic Implications Circulation, November 10, 1998; 98(19): 2030 - 2036. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Nolan, P. D. Batin, R. Andrews, S. J. Lindsay, P. Brooksby, M. Mullen, W. Baig, A. D. Flapan, A. Cowley, R. J. Prescott, et al. Prospective Study of Heart Rate Variability and Mortality in Chronic Heart Failure : Results of the United Kingdom Heart Failure Evaluation and Assessment of Risk Trial (UK-Heart) Circulation, October 13, 1998; 98(15): 1510 - 1516. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. N. Singh, S. G. Fisher, P. E. Carson, R. D. Fletcher, and the Department of Veterans Affairs CHF STAT Invest Prevalence and significance of nonsustained ventricular tachycardia in patients with premature ventricular contractions and heart failure treated with vasodilator therapy J. Am. Coll. Cardiol., October 1, 1998; 32(4): 942 - 947. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K PRASAD and M P FRENNEAUX Hypertrophic cardiomyopathy: is there a role for amiodarone? Heart, April 1, 1998; 79(4): 317 - 318. [Full Text]
|
|
|
|
 |
|
 Ventricular Tachycardia Predicts Sudden Death in CHF Journal Watch Cardiology, January 27, 1997; 1997(127): 7 - 7. [Full Text]
|
|