Ventricular tachyarrhythmia detection by implantable loop recording in patients with heart failure and preserved ejection fraction: the VIP-HF study

Dirk J. van Veldhuisen*, Gijs van Woerden, Thomas M. Gorter, Vanessa P. M. van Empel, Olivier C. Manintveld, Robert G. Tieleman, Alexander H. Maass, Kevin Vernooy, B. Daan Westenbrink, Isabelle C. van Gelder, Michiel Rienstra

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Aims The primary aim of the VIP-HF study was to examine the incidence of sustained ventricular tachyarrhythmias (VTs) in heart failure (HF) with mid-range (HFmrEF) or preserved ejection fraction (HFpEF). Secondary aims were to examine the incidence of non-sustained VTs, bradyarrhythmias, HF hospitalizations and mortality. Methods and results This was an investigator-initiated, prospective, multicentre, observational study of patients with HF and left ventricular ejection fraction (LVEF) >40%. Patients underwent extensive phenotyping, after which an implantable loop recorder was implanted. We enrolled 113 of the planned 250 patients [mean age 73 +/- 8 years, 51% women, New York Heart Association class II/III 54%/46%, median N-terminal pro B-type natriuretic peptide 1367 (710-2452) pg/mL and mean LVEF 54 +/- 6%; 75% had LVEF >50%]. Eighteen percent had non-sustained VTs and 37% had atrial fibrillation on Holter monitoring. During a median follow-up of 657 (219-748) days, the primary endpoint of sustained VT was observed in one patient. The incidence of the primary endpoint was 0.6 (95% confidence interval 0.2-3.5) per 100 person-years. The incidence of the secondary endpoint of non-sustained VT was 11.5 (7.1-18.7) per 100 person-years. Five patients developed bradyarrhythmias [3.2 (1.4-7.5) per 100 person-years], three were implanted with a pacemaker. In total, 23 patients (20%) were hospitalized for HF [16.3 (10.9-24.4) per 100 person-years]. Fourteen patients (12%) died [8.7 (5.2-14.7) per 100 person-years]; 10 due to cardiovascular causes, and four sudden deaths, one with implantable loop recorder-confirmed bradyarrhythmias as terminal event, three others undetermined. Conclusion Despite the lower than expected number of included patients, the incidence of sustained VTs in HFmrEF/HFpEF was low. Clinically relevant bradyarrhythmias were more often observed than expected.

Original languageEnglish
Pages (from-to)1923-1929
Number of pages7
JournalEuropean journal of heart failure
Volume22
Issue number10
Early online date21 Aug 2020
DOIs
Publication statusPublished - Oct 2020

Keywords

  • Heart failure with preserved ejection fraction
  • Heart failure with mid-range ejection fraction
  • Ventricular tachyarrhythmias
  • Sudden death
  • Bradyarrhythmias
  • SUDDEN CARDIAC DEATH
  • CARDIOVERTER-DEFIBRILLATOR
  • RISK STRATIFICATION
  • ESC GUIDELINES
  • ARRHYTHMIAS
  • MORTALITY
  • MODE

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