Risk Stratification for Sudden Cardiac Death In Patients With Non-ischemic Dilated Cardiomyopathy

Shekha, Karthik and Ghosh, Joydeep and Thekkoott, Deepak and Greenberg, Yisachar (2005) Risk Stratification for Sudden Cardiac Death In Patients With Non-ischemic Dilated Cardiomyopathy. [Journal (Paginated)]

Full text available as:

[img] HTML


Non ischemic dilated cardiomyopathy (NIDCM) is a disorder of myocardium. It has varying etiologies. Albeit the varying etiologies of this heart muscle disorder, it presents with symptoms of heart failure, and rarely as sudden cardiac death (SCD). Manifestations of this disorder are in many ways similar to its counterpart, ischemic dilated cardiomyopathy (IDCM). A proportion of patients with NIDCM carries a grave prognosis and is prone to sudden cardiac death from sustained ventricular arrhythmias. Identification of this subgroup of patients who carry the risk of sudden cardiac death despite adequate medical management is a challenge .Yet another method is a blanket treatment of patients with this disorder with anti arrhythmic medications or anti tachyarrhythmia devices like implantable cardioverter defibrillators (ICD). However this modality of treatment could be a costly exercise even for affluent economies. In this review we try to analyze the existing data of risk stratification of NIDCM and its clinical implications in practice.

Item Type:Journal (Paginated)
Keywords:Non Ischemic Dilated Cardiomyopathy; Ischemic Dilated Cardiomyopathy; Risk Stratification; Implantable cardioverter defibrillator; Sudden Cardiac Death
Subjects:JOURNALS > Indian Pacing and Electrophysiology Journal
ID Code:4220
Deposited By: Indian Pacing and Electrophysiology, Journal
Deposited On:16 Apr 2005
Last Modified:11 Mar 2011 08:55

References in Article

Select the SEEK icon to attempt to find the referenced article. If it does not appear to be in cogprints you will be forwarded to the paracite service. Poorly formated references will probably not work.

1. Manolio TA, Baughman KL, Rodeheffer R, et al. Prevalence and etiology of idiopathyic dilated cardiomyopathy. Am J Cardiol 1992; 69:1458-66.

2. Coughlin SS, Neaton JD, Sengupta A, Kuller LH. Predictors of mortality from idiopathyic dilated cardiomyopathy in 356,222 men screened for the Multiple Risk Factor Intervention Trial. Am J Epidemiol 1994; 139:166-72

3. Packer M, Poole-Wilson PA, Armstrong PW, Cleland JG, Horowitz JD, Massie BM, Ryden L, Thygesen K, Uretsky BF. Comparative effects of low and high doses of the angiotensin-converting enzyme inhibitor, lisinopril, on morbidity and mortality in chronic heart failure. ATLAS Study Group. Circulation 1999 Dec 7;100(23):2312-8.

4. S. Adam Strickberger, John D. Hummel, Thomas G. Bartlett, Howard I. Frumin, Claudio D. Schuger, Scott L. Beau, Cynthia Bitar, Fred Morady and AMIOVIRT Investigators. Amiodarone versus implantable cardioverter-defibrillator: randomized trial in patients with non-ischemic dilated cardiomyopathy and asymptomatic nonsustained ventricular tachycardia––AMIOVIRT. J Am Coll Cardiol 2003 May 21; 41(10):1707-12.

5. Johnson RA, Palacious I. Dilated cardiomyopathy of the adult (first of two parts). N Engl J Med 1996; 334:493-9.

6. Leclercq JF, Rosengarten MD, Attuel P, et al. Idiopathic ventricular extrasystole: right ventricular parasystole not protected from the sinus rhythm [French]? Arch Mal Coeur Vaiss 1981;74:1249-61.

7. Zaim S, Zaim B, Rottman J, Mendoza I, Nasir N Jr, Pacifico A. Characterization of spontaneous recurrent ventricular arrhythmias detected by electrogram-storing defibrillators in sudden cardiac death survivors with no inducible ventricular arrhythmias at baseline electrophysiologic testing. Am Heart J 1996 Aug; 132(2 Pt 1):274-9.

8. MERIT-HF Study Group, Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet 1999 Jun 12; 353(9169):2001-7


9. Ehlert FA, Cannom DS, Renfroe EG, Greene HL, Ledingham R, Mitchell LB, Anderson JL, Halperin BD, Herre JM, Luceri RM, Marinchak RA, Steinberg JS. Comparison of dilated cardiomyopathy and coronary artery disease in patients with life-threatening ventricular arrhythmias: Differences in presentation and outcome in the AVID registry. Am Heart J. 2001 Nov; 142(5):816-22.

10. Mehta D, Saksena S, Krol RB, Makhija V. Comparison of clinical benefits and outcome in patients with programmable and nonprogrammable implantable cardioverter defibrillators. PACE Pacing Clin Electrophysiology 1992; 15:1279-90.

11. Saksena S, Poczobutt-Johanos M, Castle LW, et al, for the Guardian Multicenter Investigators Group. Long-term multicenter experience with a second-generation implantable pacemakerdefibrillator in patients with malignant ventricular tachyarrhythmias. J Am Coll Cardiol 1992; 19:490-9.

12. Bardy GH, Troutman C, Poole JE, et al. Clinical experience with a tiered-therapy, multiprogrammable antiarrhythmia device. Circulation 1992; 85:1689-98.

13. Mirowski M, Reid PR, Mower MM, et al. Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human beings. N Engl J Med 1980; 303:322-4.

14. Lehmann MH, Steinman RT, Schuger CD, Jackson K. The automatic implantable cardioverter defibrillator as antiarrhythmic treatment modality of choice for survivors of cardiac arrest unrelated to acute myocardial infarction. Am J Cardiol 1988; 62:803-5.

15. Tchou PJ, Kadri N, Anderson J, Caceres JA, Jazayeri M, Akhtar M. Automatic implantable cardioverter defibrillators and survival of patients with left ventricular dysfunction and malignant ventricular arrhythmias. Ann Intern Med 1988; 109:529-34.

16. Fogoros RN, Fiedler SB, Elson JJ. The automatic implantable cardioverter-defibrillator in drug-refractory ventricular tachyarrhythmias. Ann Intern Med 1987;107:635-41.

17. Winkle RA, Mead RH, Ruder MA, et al. Long-term outcome with the automatic implantable cardioverter-defibrillator. J Am Coll Cardiol 1989; 13:1353-61.

18. Fogoros RN, Elson JJ, Bonnet CA, Fiedler SB, Burkholder JA. Efficacy of the automatic implantable cardioverter-defibrillator in prolonging survival in patients with severe underlying cardiac disease. J Am Coll Cardiol 1990; 16:381-6.

19. Newman D, Sauve MJ, Herre J, et al. Survival after implantation of the cardioverter defibrillator. Am J Cardiol 1992; 69:899-903.

20. Powell AC, Fuchs T, Finkelstein DM, et al. Influence of implantable cardioverter-defibrillators on the long-term prognosis of survivors of out-of-hospital cardiac arrest. Circulation 1993; 88:1083-92.

21. Crandall BG, Morris CD, Cutler JE, et al. Implantable cardioverter-defibrillator therapy in survivors of out-of-hospital sudden cardiac death without inducible arrhythmias. J Am Coll Cardiol 1993; 21:1186-92.

22. The Antiarrhythmic versus Implantable Defibrillators (AVID) Investigators. A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near fatal ventricular arrhythmias. N Engl J Med 1997; 337:1576-83.

23. Doval HC, Nul DR, Grancelli HO, Perrone SV, Bortman GR, Curiel R. Randomised trial of low-dose amiodarone in severe congestive heart failure. Grupo de Estudio de la Sobrevida en la Insuficiencia Cardiaca en Argentina (GESICA). Lancet 1994 Aug 20; 344(8921):493-8.

24. Singh SN, Fletcher RD, Fisher SG, Singh BN, Lewis HD, Deedwania PC, Massie BM, Colling C, Lazzeri D. Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia. Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure. N Engl J Med. 1995 Jul 13; 333(2):77-82.

25. Bansch D, Antz M, Boczor S, Volkmer M, Tebbenjohanns J, Seidl K, Block M, Gietzen F, Berger J, Kuck KH. Primary prevention of sudden cardiac death in idiopathic dilated cardiomyopathy: the Cardiomyopathy Trial (CAT). Circulation 2002 Mar 26; 105(12):1453-8


26. Kadish A, Quigg R, Schaechter A, Anderson KP, Estes M, Levine J. Defibrillators in non-ischemic cardiomyopathy treatment evaluation. Pacing Clin Electrophysiol. 2000 Mar; 23(3):338-43.

27. SCD-Heft Pilot Investigators, G.H. Bardy, K.L. Lee and D.B. Mark, The Sudden Cardiac Death in Heart Failure Trial: pilot study (Abstr.). PACE 20 (1997), p. 1148.

28. Fruhwald FM, Eber B, Schumacher M, et al. Syncope in dilated cardiomyopathy is a predictor of sudden cardiac death. Cardiology 1996; 87:177-80.

29. Knight BP, Goyal R, Pelosi F, Flemming M, Horwood L, Morady F, Strickberger SA. Outcome of patients with non-ischemic dilated cardiomyopathy and unexplained syncope treated with an implantable defibrillator. J Am Coll Cardiol. 1999 Jun; 33(7):1964-70.

30. Fonarow GC, Feliciano Z, Boyle NG, Knight L, Woo MA, Moriguchi JD, Laks H, Wiener I. Improved survival in patients with non-ischemic advanced heart failure and syncope treated with an implantable cardioverter-defibrillator. Am J Cardiol. 2000 Apr 15; 85(8):981-5.

31. Doval HC, Nul DR, Grancelli HO, et al.: Nonsustained ventricular tachycardia in severe heart failure: independent marker of increased mortality due to sudden death. GESICA-GEMA Investigators. Circulation 1996, 94: 3198-3203.

32. Singh SN, Fletcher RD, Fisher SG, et al.: Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia: Survival Trial of Antiarrhythmics in Congestive Heart Failure. N Engl J Med 1995, 333: 77-82.

33. Huang SK, Messer JV, Denes P: Significance of ventricular tachycardia in idiopathic dilated cardiomyopathy: observations in 35 patients. Am J Cardiol 1983, 51: 507


34. Olshausen KV, Stienen U, Math D, et al.: Long-term prognostic significance of ventricular arrhythmias in idiopathic dilated cardiomyopathy. Am J Cardiol 1988, 61: 146.

35. Becker R, Haass M, Ick D, Krueger C, Bauer A, Senges-Becker JC, Voss F, Hilbel T, Niroomand F, Katus HA, Schoels W. Role of nonsustained ventricular tachycardia and programmed ventricular stimulation for risk stratification in patients with idiopathic dilated cardiomyopathy. Basic Res Cardiol. 2003 Jul; 98(4):259-66.

36. Grimm W, Christ M, Bach J, Muller HH, Maisch B. Noninvasive arrhythmia risk stratification in idiopathic dilated cardiomyopathy: results of the Marburg Cardiomyopathy Study. Circulation. 2003 Dec 9; 108(23):2883-91.

37. Grimm W, Hoffman J, Menz V, Luck K, Maisch B. Programmed ventricular stimulation for arrhythmia risk prediction in patients with idiopathic dilated cardiomyopathy and nonsustained ventricular tachycardia. J Am Coll Cardiol 1998; 32:739-45.

38. Milner PG, DiMarco JP, Lerman BB. Electrophysiological evaluation of sustained ventricular tachyarrhythmias in idiopathic dilated cardiomyopathy. PACE Pacing Clin Electrophysiology 1988; 11:562-8.

39. Das SK, Morady F, DiCarlo L Jr, Baerman J, Krol R, De Buitleir M, Crevey B. Prognostic usefulness of programmed ventricular stimulation in idiopathic dilated cardiomyopathy without symptomatic ventricular arrhythmias. Am J Cardiol 1986 Nov 1; 58(10):998-1000.

40. Stamato NJ, O'Connell JB, Murdock DK, Moran JF, Loeb HS, Scanlon PJ. The response of patients with complex ventricular arrhythmias secondary to dilated cardiomyopathy to programmed electrical stimulation. Am Heart J. 1986 Sep; 112(3):505-8.

41. Meinertz T, Treese N, Kasper W, et al.: Determinants of prognosis in idiopathic dilated cardiomyopathy as determined by programmed electrical stimulation. Am J Cardiol 1985, 56: 337-341.

42. Galinier M, Albenque JP, Afchar N, Fourcade J, Massabuau P, Doazan JP, Legoanvic C, Fauvel JM, Bounhoure JP. Prognostic value of late potentials in patients with congestive heart failure. Eur Heart J 1996 Feb; 17(2):264-71


43. Fauchier L, Babuty D, Cosnay P, Poret P, Rouesnel P, Fauchier JP. Long-term prognostic value of time domain analysis of signal-averaged electrocardiography in idiopathic dilated cardiomyopathy. Am J Cardiol 2000 Mar 1; 85(5):618-23.

44. Mancini DM, Wong KL, Simson MB. Prognostic value of an abnormal signal-averaged electrocardiogram in patients with non-ischemic congestive cardiomyopathy. Circulation. 1993 Apr; 87(4):1083-92.

45. Brembilla-Perrot B, Terrier de la Chaise A, Jacquemin L, Beurrier D, Houplon P. The signal-averaged electrocardiogram is of limited value in patients with bundle branch block and dilated cardiomyopathy in predicting inducible ventricular tachycardia or death. Am J Cardiol. 1997 Jan 15; 79(2):154-9.

46. Grimm W, Steder U, Menz V, Hoffman J, Maisch B. QT dispersion and arrhythmic events in idiopathic dilated cardiomyopathy. Am J Cardiol 1996 Aug 15; 78(4):458-61.

47. La Rovere MT, Pinna GD, Hohnloser SH, Marcus FI, Mortara A, Nohara R, Bigger JT Jr, Camm AJ, Schwartz PJ; ATRAMI Investigators. Autonomic Tone and Reflexes After Myocardial Infarction. Baroreflex sensitivity and heart rate variability in the identification of patients at risk for life-threatening arrhythmias: implications for clinical trials. Circulation. 2001 Apr 24; 103(16):2072-7.

48. Grimm W, Herzum I, Muller HH, Christ M. Value of heart rate variability to predict ventricular arrhythmias in recipients of prophylactic defibrillators with idiopathic dilated cardiomyopathy. Pacing Clin Electrophysiology 2003 Jan; 26(1 Pt 2):411-5.

49. Fauchier L, Babuty D, Cosnay P, Autret ML, Fauchier JP. Heart rate variability in idiopathic dilated cardiomyopathy: characteristics and prognostic value. J Am Coll Cardiol 1997 Oct; 30(4):1009-14.

50. Karcz M, Chojnowska L, Zareba W, Ruzyllo W. Prognostic significance of heart rate variability in dilated cardiomyopathy. Int J Cardiol. 2003 Jan; 87(1):75-81.

51. Menz V, Grimm W, Hoffmann J, Born S, Schmidt C, Maisch B. Baroreflex sensitivity and heart rate variability in coronary disease compared to dilated cardiomyopathy. Pacing Clin Electrophysiology. 1998 Nov; 21(11 Pt 2):2416-9.

52. Kitamura H, Ohnishi Y, Okajima K, Ishida A, Galeano E, Adachi K, Yokoyama M. Onset heart rate of microvolt-level T-wave alternans provides clinical and prognostic value in non-ischemic dilated cardiomyopathy. J Am Coll Cardiol. 2002 Jan 16; 39(2):295-300.

53. Adachi K, Ohnishi Y, Shima T, Yamashiro K, Takei A, Tamura N, Yokoyama M. Determinant of microvolt-level T-wave alternans in patients with dilated cardiomyopathy. J Am Coll Cardiol. 1999 Aug;34(2):374-80.

54. Kondo N, Ikeda T, Kawase A, Kumagai K, Sakata T, Takami M, Tezuka N, Nakae T, Noro M, Enjoji Y, Sugi K, Yamaguchi T. Clinical usefulness of the combination of T-wave alternans and late potentials for identifying high-risk patients with moderately or severely impaired left ventricular function. Jpn Circ J. 2001 Jul; 65(7):649-53.

55. Hohnloser SH, Klingenheben T, Bloomfield D, Dabbous O, Cohen RJ. Usefulness of microvolt T-wave alternans for prediction of ventricular tachyarrhythmic events in patients with dilated cardiomyopathy: results from a prospective observational study. J Am Coll Cardiol 2003 Jun; 41(12):2220-2224.

56. Gomes JA, Winters SL, Martinson M, Machac J, Stewart D, Targonski A. The prognostic significance of quantitative signal-averaged variables relative to clinical variables, site of myocardial infarction, ejection fraction and ventricular premature beats: a prospective study. J Am Coll Cardiol 1989; 13:377-84.

57. Keeling PJ, Kulakowski P, Yi G, Slade AK, Bent SE, McKenna WJ. Usefulness of signal-averaged electrocardiogram in idiopathic dilated cardiomyopathy for identifying patients with ventricular arrhythmias. Am J Cardiol 1993; 72:78-84.

58. Cripps T, Bennett ED, Camm AJ, Ward DE. High-gain signal averaged electrocardiogram combined with 24-h monitoring in patients early after myocardial infarction for bedside prediction of arrhythmic events. Br Heart J 1988; 60:181-7.

59. Hoffmann J, Grimm W, Menz V, Knop U, Maisch B. Heart rate variability and major arrhythmic events in patients with idiopathic dilated cardiomyopathy. Pacing Clin Electrophysiology 1996; 19:1841-4


60. La Rovere MT, Specchia G, Mortara A, Schwartz PJ. Baroreflex sensitivity, clinical correlates, and cardiovascular mortality among patients with a first myocardial infarction: a prospective study. Circular 1988; 78:816-24.

61. Hammill SC, Trusty JM, Wood DL, Bailey KR, Vatterott PJ, Osborn MJ, Holmes DR Jr, Gersh BJ. Influence of ventricular function and presence or absence of coronary artery disease on results of electrophysiologic testing for asymptomatic nonsustained ventricular tachycardia. Am J Cardio 1990 Mar 15;65(11):722-8.

62. Hoffmann J, Grimm W, Menz V, Muller HH, Maisch B. Heart rate variability and baroreflex sensitivity in idiopathic dilated cardiomyopathy. Heart 2000 May;83(5):531-8


63. Johnson Francis, Mari A Watanabe. George Schmidt. Heart rate turbulence: a new predictor for risk of Sudden cardiac death. Ann Noninvasive Electrocardiol. 2005 Jan;10(1):102-9.

64. Przemystaw Guzik. Georg Schmidt. A phenomenon of heart Rate turbulence, Its Evaluation and prognostic value. Cardiac c electrophysiology review 2002;6:256-262.

65. Wolfram Grimm. Julia Sharkova .Michael Christ. Hans-helge Muller. .Georg Schmidt. Bernard Maisch. Prognostic Significance of heart rate turbulence following ventricular premature beats in patients with idiopathic dilated cardiomyopathy J cardiovascular electrophysiol, 2003:14;819-824.


Repository Staff Only: item control page