Predictive value of electrophysiological study for risk stratification of ventricular tachyarrhythmias in patients with non-ischemic cardiomyopathy and chronic systolic heart failure

N N Ilov,D G Tarasov

doi:10.35336/va-2021-4-34-44

Abstract

A systematic review and meta-analysis of studies providing information on the use of intracardiac electrophysiological study (EPS) to stratify the risk of ventricular tachyarrhythmia (VT) in patients with non-ischemic chronic heart failure with low left ventricle ejection fraction (HFrEF). Relevant publications were searched until 20.01.2021 by two independent researchers in major search engines, electronic archives of clinical research, and open access preservatives repository. The end point considered was an episode of sudden cardiac death or sustained paroxysm of VT, or an appropriate electrotherapy of an implanted cardiac defibrillator. Ten clinical trials with 608 relevant patients (mean age: 51.5 ± 12 years; mean left ventricle EF: 26.8±8.5%, NYHA class: I - 17.7%; II - 33.7%; III - 35.9%, IV - 12.7%) were selected. The end point was registered in 92 patients (15.1%): in 47 patients (43.9%) with previously induced VT during EPS and in 45 patients (8.9%) without VT. The diagnostic odds ratio was 5.57 (2.27-13.63). The combined sensitivity and specificity of the EPS were 42% (26-61%) and 88% (83-92%) respectively. The results indicate the potential of EPS to stratify the arrhythmic risk in patients with non-ischemic HFrEF.

Highlights

The end point considered was an episode of sudden cardiac death or sustained paroxysm of ventricular tachyarrhythmia (VT), or an appropriate electrotherapy of an implanted cardiac defibrillator
The end point was registered in 92 patients (15.1%): in 47 patients (43.9%) with previously induced VT during electrophysiological study (EPS) and in 45 patients (8.9%) without VT
The results indicate the potential of EPS to stratify the arrhythmic risk in patients with non-ischemic HFrEF

Summary

МАТЕРИАЛЫ И МЕТОДЫ АНАЛИЗА

Систематический обзор и мета-анализ были проведены в соответствии с положениями инструкции «Предпочтительные параметры отчетности для систематических обзоров и мета-анализа» (PRISMA) [23]. Стратегия поиска, отбор данных В поисковых системах MEDLINE/PubMed, Google scholar, ScienceDirect, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) был проведен поиск по ключевым словам на английском языке: «sudden cardiac death», «ventricular arrhythmia», «electrophysiological study», «invasive risk stratification», «non-ischemic cardiomyopathy», «dilated cardiomyopathy» и их русскоязычных аналогов «внезапная сердечная смерть», «желудочковая аритмия», «электрофизиологическое исследование», «инвазивная стратификация риска», «неишемическая кардиомиопатия», «дилатационная кардиомиопатия». Для того чтобы сбалансировать специфичность и чувствительность поисковой стратегии группы ключевых слов объединялись между собой с помощью операторов OR (ИЛИ) и AND (И).

Оценка исходов

ПОЛУЧЕННЫЕ РЕЗУЛЬТАТЫ

Число экстрастимулов

ОБСУЖДЕНИЕ ПОЛУЧЕННЫХ РЕЗУЛЬТАТОВ

Findings

ОГРАНИЧЕНИЯ ИССЛЕДОВАНИЯ