Ambulatory ventricular arrhythmias in patients with heart failure do not specifically predict an increased risk of sudden death

John R. Teerlink, Muhammad Jalaluddin, Susan Anderson, Marrick L. Kukin, Eric J. Eichhorn, Gary Francis, Milton Packer, Barry M. Massie

Research output: Contribution to journalArticle

173 Citations (Scopus)

Abstract

Background - Ventricular arrhythmias are a frequent finding in congestive heart failure (CHF) patients and a cause of concern for physicians caring for them. Previous studies have reached conflicting conclusions regarding the importance of ventricular arrhythmias as predictors of sudden death in patients with CHF. This study examined the independent predictive value of ventricular arrhythmias for sudden death and all-cause mortality in PROMISE (Prospective Randomized Milrinone Survival Evaluation). Methods and Results Ventricular arrhythmias were analyzed and quantified by use of prespecified criteria on baseline ambulatory ECGs from 1080 patients with New York Heart Association (NYHA) class III/IV symptoms and a left ventricular ejection fraction ≤35% enrolled in PROMISE. The relationship of ventricular arrhythmias and other clinical parameters to overall mortality and sudden death classified by an independent, blinded mortality committee was determined. There were 290 deaths, of which 139 were classified as sudden. Of the several measures of ventricular ectopy that were univariate predictors, the frequency of nonsustained ventricular tachycardia (NSVT) was the most powerful predictor and remained a significant independent predictor when included with other clinical variables in multivariate models of both sudden death mortality and non-sudden death mortality. However, multiple logistic analysis with models including the clinical variables with and without the NSVT variable demonstrated that the frequency of NSVT did not add significant' information beyond the clinical variables. Conclusions - This study demonstrates that ventricular arrhythmias do not specifically predict sudden death in patten with moderate-to-severe heart failure. Thus, the finding of asymptomatic NSVT on ambulatory ECG does not identity specific candidates for antiarrhythmic or device therapy.

Original languageEnglish (US)
Pages (from-to)40-46
Number of pages7
JournalCirculation
Volume101
Issue number1
StatePublished - Jan 4 2000

Fingerprint

Sudden Death
Cardiac Arrhythmias
Heart Failure
Ventricular Tachycardia
Mortality
Milrinone
Electrocardiography
Survival
Stroke Volume
Physicians
Equipment and Supplies

Keywords

  • Arrhythmia
  • Death, sudden
  • Heart failure
  • Inotropic agents
  • Prognosis

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Teerlink, J. R., Jalaluddin, M., Anderson, S., Kukin, M. L., Eichhorn, E. J., Francis, G., ... Massie, B. M. (2000). Ambulatory ventricular arrhythmias in patients with heart failure do not specifically predict an increased risk of sudden death. Circulation, 101(1), 40-46.

Ambulatory ventricular arrhythmias in patients with heart failure do not specifically predict an increased risk of sudden death. / Teerlink, John R.; Jalaluddin, Muhammad; Anderson, Susan; Kukin, Marrick L.; Eichhorn, Eric J.; Francis, Gary; Packer, Milton; Massie, Barry M.

In: Circulation, Vol. 101, No. 1, 04.01.2000, p. 40-46.

Research output: Contribution to journalArticle

Teerlink, JR, Jalaluddin, M, Anderson, S, Kukin, ML, Eichhorn, EJ, Francis, G, Packer, M & Massie, BM 2000, 'Ambulatory ventricular arrhythmias in patients with heart failure do not specifically predict an increased risk of sudden death', Circulation, vol. 101, no. 1, pp. 40-46.
Teerlink JR, Jalaluddin M, Anderson S, Kukin ML, Eichhorn EJ, Francis G et al. Ambulatory ventricular arrhythmias in patients with heart failure do not specifically predict an increased risk of sudden death. Circulation. 2000 Jan 4;101(1):40-46.
Teerlink, John R. ; Jalaluddin, Muhammad ; Anderson, Susan ; Kukin, Marrick L. ; Eichhorn, Eric J. ; Francis, Gary ; Packer, Milton ; Massie, Barry M. / Ambulatory ventricular arrhythmias in patients with heart failure do not specifically predict an increased risk of sudden death. In: Circulation. 2000 ; Vol. 101, No. 1. pp. 40-46.
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AB - Background - Ventricular arrhythmias are a frequent finding in congestive heart failure (CHF) patients and a cause of concern for physicians caring for them. Previous studies have reached conflicting conclusions regarding the importance of ventricular arrhythmias as predictors of sudden death in patients with CHF. This study examined the independent predictive value of ventricular arrhythmias for sudden death and all-cause mortality in PROMISE (Prospective Randomized Milrinone Survival Evaluation). Methods and Results Ventricular arrhythmias were analyzed and quantified by use of prespecified criteria on baseline ambulatory ECGs from 1080 patients with New York Heart Association (NYHA) class III/IV symptoms and a left ventricular ejection fraction ≤35% enrolled in PROMISE. The relationship of ventricular arrhythmias and other clinical parameters to overall mortality and sudden death classified by an independent, blinded mortality committee was determined. There were 290 deaths, of which 139 were classified as sudden. Of the several measures of ventricular ectopy that were univariate predictors, the frequency of nonsustained ventricular tachycardia (NSVT) was the most powerful predictor and remained a significant independent predictor when included with other clinical variables in multivariate models of both sudden death mortality and non-sudden death mortality. However, multiple logistic analysis with models including the clinical variables with and without the NSVT variable demonstrated that the frequency of NSVT did not add significant' information beyond the clinical variables. Conclusions - This study demonstrates that ventricular arrhythmias do not specifically predict sudden death in patten with moderate-to-severe heart failure. Thus, the finding of asymptomatic NSVT on ambulatory ECG does not identity specific candidates for antiarrhythmic or device therapy.

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