Abstract 11047: The Use of Electrophysiology Studies in the Post-AVID and Post-SCD-HeFT Era: Data from the NCDR® ICD Registry™
Introduction: Electrophysiology studies (EPS) have historically played a role in sudden death risk stratification. However, more recent studies have focused on ejection fraction (EF) as the primary guide to ICD implantation. The utilization of EPS in patients undergoing ICD implantation in the current era remains unknown.
Methods: Patients undergoing de novo ICD implantation in the NCDR® ICD Registry™ between July 2006 and June 2009 who also underwent EPS within 30 days prior to implant were compared to the remaining cohort in order to identify clinical characteristics that correlated with performance of EPS. Patients undergoing EPS according to published guidelines and those who already met 2005 CMS criteria for primary prevention ICD implantation were also defined. Arrhythmias induced by EPS were subsequently analyzed.
Results: EPS were performed in 33,786 of 275,273 patients. Those undergoing EPS were more likely to have had a history of syncope, family history of sudden death, lack of congestive heart failure, and higher EF (Table). Current published guidelines accounted for 51.4% of EPS performed. Among the primary prevention ICD cohort, 82.2% of EPS were performed in those who already met criteria for an ICD. No ventricular tachyarrhythmias were induced in 18.9% of EPS. The most common type of arrhythmia induced was sustained monomorphic ventricular tachycardia.
Conclusions: EPS were performed in those with borderline ICD indications or less well defined risk factors for sudden death. While EPS may influence management decisions in various ways, 82.2% of EPS in primary prevention ICD patients already fulfilled criteria for an ICD based on EF and heart failure status. These results suggest that many physicians question the utility of existing guidelines and are searching for better means to identify patients most likely to benefit from ICDs. Consideration should be made for clarifying indications for EPS in patients undergoing ICD implantation.
- © 2010 by American Heart Association, Inc.