Abstract 11333: Identifying Patients at Low Risk for Ventricular Tachycardia After Cardiac Resynchronisation
Introduction: Ruling out scar as a substrate and ischemia as a trigger of ventricular tachyarrhythmia could define patients (pts) at low risk for adequate ICD-therapies despite poor left ventricular ejection fraction (LVEF). The modified Selvester-ECG-score (MSES) correlates with the LV scar burden. Every 1 point raise counts for 3% additional scar. In a retrospective analysis of SCD-HeFT it has shown a value in describing pts at high vs low risk for ICD-therapy. Its value in pts with non-ischemic cardiomyopathy and indication for CRT has not yet been described.
Hypothesis:A low MSES, non-ischemic cardiomyopathy and CRT can define pts at low risk for adequate ICD-therapies
Methods: We studied 54 pts who underwent primary prophylactic CRT-D implantation at our department, had non-ischemic cardiomyopathy and complete follow up of device interrogation for 1 year. For 44 of these pts a complete follow up of 2 years was obtainable. Pts with upgrade from existing devices were not studied.
Results: Mean LVEF was 21,1% (range 10,0%-30,0%), median MSES was 3 (0-11). 9/54 pts suffered adequate ICD-therapy in the first year, 12/44 over the 2 year period. The LVEF of pts with and without ICD-therapy did not differ significantly. Median MSES was 6 in the therapy group and 3 in pts without therapy. No pt with an MSES of 3 or less suffered an ICD-therapy. The risk for ICD-therapy in pts with an MSES of 4 or more vs. 3 or less showed a significant difference: relative risk was for the first year 20,4 (95% CI 1,3-334,0, p=0,03), for the 2 year period 21,0 (95% CI 1.3-334.0, p=0.03). Calculating the relative risk using a LVEF cut-off of 20% lead to no significant results in both periods. LVEF and MSES showed no correlation (spearman’s rho -0,12, two-tailed p = 0,37).
Conclusions: We could clearly demonstrate that applying the modified Selvester-ECG-score to pts with non-ischemic cardiomyopathy and indication for CRT is a promising way to identify pts at low risk for ICD-therapy. The score is superior to LVEF and does not correlate with it. In particular pts with a score ≤ 3 have a very low risk for adequate ICD-therapy. Management of pts with indication for CRT could be improved by use of this parameter, particularly with regard to the question if a CRT-P is an alternative in more pts.
Author Disclosures: M. Grett: None. H. Trappe: None.
- © 2014 by American Heart Association, Inc.