Predictive value of programmed ventricular stimulation in patients with ischaemic cardiomyopathy: implications for the selection of candidates for an implantable defibrillator

Aims The present study assessed the role of programmed ventricular stimulation (PVS) in risk stratification of patients with ischaemic cardiomyopathy (ICM), candidates for implantable cardioverter-defibrillator (ICD). Methods and results Consecutive patients with ICM and LVEF ≤ 40% ( n = 106, age 61 ± 7 years, LVEF 27 ± 7%) underwent PVS. This was considered positive in case of inducibility of monomorphic ventricular tachycardia (VT) with ≤3 extrastimuli; polymorphic VT, ventricular fibrillation (VF), and fast monomorphic VT (CL ≤ 230 ms) with ≤2 extrastimuli. Primary end-point was the combination of arrhythmic death and VF requiring ICD shock. Forty-nine patients (46%) were inducible at PVS; 74 (70%) were implanted with ICD. During a 24-month follow-up, the primary end-point occurred more frequently in positive PVS patients among the overall population, among patients with LVEF ≤ 30% ( n = 80) and among patients with an ICD. The negative predictive value of PVS was 96% in each group. In the overall population, both PVS (HR 7.32, 95% CI 1.6–32) and LVEF (HR 4.59, 95% CI 1.6–13) predicted the primary end-point. Conclusion PVS may still have a role in predicting the arrhythmic risk in patients with ICM. A negative PVS identifies a subgroup with a very low risk of arrhythmic events even in patients with LVEF ≤ 30%.