Abstract 630 Syncope does not predict long-term outcome in patients with inducible ventricular arrhythmias: Insights from the German Device Registry

Background:
Unexplained syncope is an independent predictor for sudden cardiac death and appropriate device discharge. However, its relevance in patients with inducible ventricular arrhythmias (VA) during programmed ventricular stimulation (PVS) is unknown. Here, we analyzed the predictive value of a history of syncope on procedural outcome following device implantation in patients with inducible VA.

Methods:
Patients enrolled in the prospective, multi-center German Device Registry undergoing device implantation after PVS with inducible VA between 2007 and 2010 were investigated. The study population was divided into patients with versus without a history of syncope.

Results:
Among 4196 patients included in the registry, 343 (8.2%) had inducible VA during PVS. Patients with a history of syncope (n=257, 65.1±14.6 years, 81.3% male) presented less often with coronary artery disease (56.4% vs 70.9%; P=0.017), prior myocardial infarction (33.1% vs 46.5%; P=0.025), congestive heart failure (3.9% vs 20.9%; P<0.001), dyspnea (2.3% vs 15.1%; P<0.001) and without any other symptoms (0% vs 43.0%; P<0.001) than those without syncope (n=86, 65.5±12.2 years, 86.0% male). No differences were found in terms of device complications (2.4% vs 1.2%; P=0.68), rehospitalization (27.6% vs 21.7%; P=0.37), improvement in quality of life (44.0% vs 47.5%; P=0.64), experience of a syncope following device implantation (3.0% vs 0%; P=0.32), MACCE (6.0% vs 2.8%; P=0.29) and 1-year-mortality (4.6% vs 2.8%; P=0.51).

Conclusion:
Inducibility of VA is a rare indication for device implantation. Among patients with inducible VA during PVS, complication and mortality rates do not differ between those with versus without a history of syncope, indicating that the experience of a syncope does not predict long-term outcome in this population.

Figure: Outcomes at 1-year-follow-up do not differ between patients with versus without a history of syncope.
Endpoints are shown for patients with versus without syncope undergoing device implantation after programmed ventricular stimulation with inducible ventricular arrhythmia. There were no differences between groups.

ICD, implantable cardioverter-defibrillator; MACCE, major adverse cardiac or cerebrovascular event; VT, ventricular tachycardia.

Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Syncope does not predict long-term outcome in patients with inducible ventricular arrhythmias: Insights from the German Device Registry
A.-K. Kahle¹, J. Senges², M. Hochadel³, D. Thomas⁴, F. Straube⁵, K. Bonaventura⁶, J. vom Dahl⁷, N. Werner⁸, C. Butter⁹, K. Scherschel¹, C. Meyer¹, für die Studiengruppe: Deutsches Deviceregister
¹Klinik für Kardiologie, Evangelisches Krankenhaus Düsseldorf, Düsseldorf; ²Stiftung Institut für Herzinfarktforschung, Ludwigshafen am Rhein; ³Medizinische Klinik B, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen am Rhein; ⁴Klinik für Innere Med. III, Kardiologie, Angiologie u. Pneumologie, Universitätsklinikum Heidelberg, Heidelberg; ⁵Klinik für Kardiologie und Internistische Intensivmedizin, München Klinik Bogenhausen, München; ⁶Klinik für Kardiologie, Angiologie und konservative Intensivmedizin, Klinikum Ernst von Bergmann gGmbH, Potsdam; ⁷Klinik für Kardiologie und Int. Intensivmedizin, Krankenhaus St. Franziskus, Kliniken Maria Hilf GmbH, Mönchengladbach; ⁸Innere Medizin III, Krankenhaus der Barmherzigen Brüder Trier, Trier; ⁹Herzzentrum Brandenburg / Kardiologie, Immanuel Klinikum Bernau, Bernau bei Berlin;
Background: Unexplained syncope is an independent predictor for sudden cardiac death and appropriate device discharge. However, its relevance in patients with inducible ventricular arrhythmias (VA) during programmed ventricular stimulation (PVS) is unknown. Here, we analyzed the predictive value of a history of syncope on procedural outcome following device implantation in patients with inducible VA. Methods: Patients enrolled in the prospective, multi-center German Device Registry undergoing device implantation after PVS with inducible VA between 2007 and 2010 were investigated. The study population was divided into patients with versus without a history of syncope. Results: Among 4196 patients included in the registry, 343 (8.2%) had inducible VA during PVS. Patients with a history of syncope (n=257, 65.1±14.6 years, 81.3% male) presented less often with coronary artery disease (56.4% vs 70.9%; P=0.017), prior myocardial infarction (33.1% vs 46.5%; P=0.025), congestive heart failure (3.9% vs 20.9%; P<0.001), dyspnea (2.3% vs 15.1%; P<0.001) and without any other symptoms (0% vs 43.0%; P<0.001) than those without syncope (n=86, 65.5±12.2 years, 86.0% male). No differences were found in terms of device complications (2.4% vs 1.2%; P=0.68), rehospitalization (27.6% vs 21.7%; P=0.37), improvement in quality of life (44.0% vs 47.5%; P=0.64), experience of a syncope following device implantation (3.0% vs 0%; P=0.32), MACCE (6.0% vs 2.8%; P=0.29) and 1-year-mortality (4.6% vs 2.8%; P=0.51). Conclusion: Inducibility of VA is a rare indication for device implantation. Among patients with inducible VA during PVS, complication and mortality rates do not differ between those with versus without a history of syncope, indicating that the experience of a syncope does not predict long-term outcome in this population. Figure: Outcomes at 1-year-follow-up do not differ between patients with versus without a history of syncope. Endpoints are shown for patients with versus without syncope undergoing device implantation after programmed ventricular stimulation with inducible ventricular arrhythmia. There were no differences between groups. ICD, implantable cardioverter-defibrillator; MACCE, major adverse cardiac or cerebrovascular event; VT, ventricular tachycardia.
https://dgk.org/kongress_programme/jt2022/aP491.html