European Heart Journal Advance Access first published online on July 18, 2007
This version published online on August 18, 2007
European Heart Journal, doi:10.1093/eurheartj/ehm242
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Incidence of ventricular tachyarrhythmias during permanent pacemaker therapy in low-risk patients results from the German multicentre EVENTS study
1 Department of Cardiology and Angiology, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
2 Guidant GmbH, Germany
3 Klinikum Coburg, Germany
Received 23 October 2006; revised 6 May 2007; accepted 18 May 2007.
* Corresponding author. Tel: +49 761 270 3548; fax: +49 761 270 7309. E-mail address: faber{at}med1.ukl.uni-freiburg.de
Aims: Current studies found an incidence of 12–31% ventricular tachyarrhythmias and sudden cardiac death during cardiac pacing months or even years after pacemaker insertion. MADIT12 and MUSTT13 demonstrated that patients with poor LV function after Myocardial infarction (MI) showing non-sustained ventricular tachycardia (nsVT) and inducibility during electrophysiologic testing benefit from an ICD. The present study was dedicated to assess the global incidence of non-sustained ventricular arrhythmias in a general population of pacemaker patients. Special regard was on patients with a potential ICD indication, e.g. those matching the MADIT/MUSTT criteria.
Methods and results: Two hundred and thirty-one patients (72 ± 11 years; 134 men) with an indication for dual chamber pacing entered the study. In all patients pacemaker systems capable of automatic storing of intracardiac electrocardiograms were implanted (Pulsar®, Discovery®, Guidant). Follow-up time was 15 months after inclusion. In 54 (25.7%) of 210 patients with at least one follow-up, episodes of nsVT were documented by stored electrocardiograms (up to >30 beats, >200 b.p.m.). Multiple—up to nine—episodes of ventricular tachycardia were retrieved in 31 of these patients. Three out of 14 patients with an LVEF <40% after MI presented nsVT during the follow-up. One of these patients received an ICD.
Conclusion: A significant number of pacemaker patients present with ventricular tachycardia. Intracardiac electrocardiograms and alert functions from pacemakers may enhance physicians' awareness of the patient's intrinsic arrhythmic profile and help uncover underlying mechanisms of arrhythmias by storing the initiation of the arrhythmia.
Key Words: Ventricular arrhythmia • Pacemaker • Sudden death
The originally published version of this paper was incorrect. The author affiliations and conflict of interest information has been amended.