Risk of arrhythmic death in ischemic heart disease: a prospective, controlled, observer-blind risk stratification over 10 years

Eur J Clin Invest. 2017 Mar;47(3):231-240. doi: 10.1111/eci.12729. Epub 2017 Feb 11.


Background: Risk of arrhythmic death is considered highest in ischemic heart disease with severe left ventricular ejection fraction (LVEF) reduction. Non-invasive testing should improve decision-making of prophylactic defibrillator (ICD) implantation.

Design: We enrolled 120 patients with ischemic heart disease and LVEF < 50% and 30 control subjects without ischemic heart disease and normal LVEF. An initial assessment, a second assessment after 3 years and a final follow-up comprised of pharmacological baroreflex testing (BRS), short-term spectral [low-frequency (LF) to high-frequency (HF) ratio] and long-term time-domain analysis of heart rate variability (SDNN), exercise Microvolt T-wave alternans (MTWA) and others.

Results: The median follow-up was 7·5 years. Resuscitated cardiac arrest and arrhythmic death due to ventricular arrhythmias ≥ 240/min was observed in 18% and 15% of patients, respectively. Cardiac death was observed in 28% of patients. The incidence of arrhythmic death and resuscitated cardiac arrest was identical in patients with ischemic heart disease with LVEF < 30% and ≥ 30%. No significant difference between subgroups with LVEF of < 30%, 30-39% and ≥ 40% was found either. MTWA, BRS, SDNN and LF to HF ratio failed to identify patients at risk of arrhythmic death in a multiple regression model.

Conclusions: Ischemic heart disease patients with LVEF < 30% and ≥ 30% face the same risk of arrhythmic death. Stratification techniques fail to identify high-risk patients. Therefore, the current practice to constrain prophylactic ICDs to patients with severely reduced LVEF seems to be insufficient.

Keywords: Ischemic heart disease; non-invasive risk stratification; sudden cardiac death.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Arrhythmias, Cardiac / etiology*
  • Arrhythmias, Cardiac / mortality
  • Case-Control Studies
  • Death, Sudden, Cardiac / etiology*
  • Female
  • Follow-Up Studies
  • Heart Rate
  • Humans
  • Male
  • Middle Aged
  • Myocardial Ischemia / complications*
  • Myocardial Ischemia / mortality
  • Prospective Studies
  • Risk Assessment
  • Single-Blind Method
  • Time Factors
  • Ventricular Dysfunction, Left / physiopathology*