Recurrence of ventricular arrhythmias in patients with non- -ischaemic dilated cardiomyopathy: evidence-based predictors

Background: Ventricular arrhythmia (VA) is the most frequent cause of sudden death among patients with non-ischaemic dilated cardiomyopathy (DCM). Aim: To identify the important VA risk factors in patients with DCM. Methods and results: Eighty-five DCM patients (73 males, mean age 54 years) with DCM and implantable cardioverter defibrillators (ICD) were followed for 21 ± 19 months after ICD implantation. The mean follow-up was 21 months. Data from 55 patients with VA recorded in the ICD memory and requring ICD intervention during follow-up were compared with 30 patients without arrhythmia. Cox regression analysis identified the following univariate predictors of VA: alcoholic aetiology of DCM (0.05), diuretic treatment (0.003), history of cardiac arrest (0.03), right ventricular diastolic diameter (0.001). Both ACE inhibitor (ACEI) and statin treatments were associated with a tendency towards decreased risk of VA. Multivariate logistic analysis identified four predictors as significantly related to VA: alcoholic aetiology (HR 4.8, p = 0.008), ACEI treatment (HR 0.4, p = 0.01), diuretic treatment (HR 2.6, p = 0.015), and statin treatment (HR 0.1, p = 0.03). Conclusions: The majority of patients with DCM and ICD have recurrences of VA. Alcoholic aetiology of DCM is associated with an increase in the incidence of arrhythmias. Treatment with ACEI and statins is associated with a reduction of arrhythmias.