Ventricular Tachycardia Clinical Trial
Official title:
Post-Extrasystolic Potentiation as a Predictor of Ventricular Arrhythmias
Background: Patients at increased risk for sudden cardiac death (SCD) may receive an
implantable cardioverter defibrillator (ICD). The primary criterion for a primary prevention
ICD implantation is a left ventricular ejection fraction (LVEF) below 35%, but refinement of
ICD criteria is important since only a small proportion of ICD patients receives appropriate
device therapy (ATP or a shock) during follow-up. Post-extrasystolic potentiation (PESP) may
be a new risk marker for SCD. PESP is defined as a temporary increase in contractility that
follows an extrasystolic beat (ESB) and is associated with myocardial calcium handling. In
heart failure, changes in calcium homeostasis may lead to afterdepolarisations and thus
predispose for SCD. PESP can be measured indirectly and non-invasively as post-extrasystolic
blood pressure potentiation (PESP-BP). Abnormal PESP-BP was previously found to be an
independent predictor of increased mortality in post-myocardial infarction patients with a
reduced LVEF. However, it is unknown if this increased mortality in heart failure patients
with abnormal PESP-BP is caused by an increased risk of SCD.
Hypothesis: The investigators hypothesize that PESP-BP might be a new predictor of the
occurrence of SCD, and can be used to enhance patient selection for primary prevention ICD
therapy.
Design: During scheduled device replacement ESB with various extrasystolic and
post-extrasystolic coupling intervals will be evoked by electrical stimulation via the right
atrial and ventricular device leads of the patient. Throughout the stimulation study blood
pressure will be measured non-invasively a continuous electrocardiogram will be recorded.
Either before or after the procedure, patients will undergo a 30-minutes assessment of
spontaneous ESB, again with blood pressure and ECG recordings.
Study population: 30 patients who are scheduled for device replacement or reposition, are
eligible for this study; (1) 10 ICD patients who previously received appropriate device
therapy (ADT); (2) 10 ICD patients who are free from ADT and (3) 10 dual-chamber pacemaker
patients (control group).
Outcomes: (1) Evoked PESP-BP (i.e. blood pressure differences between baseline, ESB and
post-ESB); (2) Spontaneous PESP-BP (i.e. blood pressure differences between baseline, ESB and
post-ESB); (3) Timing parameters (in ms): the basic cycle length interval; Extra-systolic
interval (ESI); Post-extrasystolic interval (PESI).
n/a
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