Ambulatory ventricular arrhythmias in patients with heart failure do not specifically predict an increased risk of sudden death

Background-Ventricular arrhythmias are a frequent finding in congestive hea rt failure (CHF) patients and a cause of concern for physicians caring for them. Previous studies have reached conflicting conclusions regarding the i mportance of ventricular arrhythmias as predictors of sudden death in patie nts with CHF. This study examined the independent predictive value of ventr icular arrhythmias for sudden death and all-cause mortality in PROMISE (Pro spective Randomized Milrinone Survival Evaluation). Methods and Results-Ventricular arrhythmias were analyzed and quantified by use of prespecified criteria on baseline ambulatory ECGs from 1080 patient s with New York Heart Association (NYHA) class III/IV symptoms and a left v entricular ejection fraction less than or equal to 35% enrolled in PROMISE. The relationship of ventricular arrhythmias and other clinical parameters to overall. mortality and sudden death classified by an independent, blinde d mortality committee was determined. There were 290 deaths, of which 139 w ere classified as sudden. Of the several measures of ventricular ectopy tha t were univariate predictors, the frequency of nonsustained ventricular tac hycardia (NSVT) was the most powerful predictor and remained a significant independent predictor when included with other clinical variables in multiv ariate models of both sudden death mortality and non-sudden death mortality , However, multiple logistic analysis with models including the clinical va riables with and without the NSVT variable demonstrated that the frequency of NSVT did not add significant information beyond the clinical variables. Conclusions-This study demonstrates that ventricular arrhythmias do not spe cifically predict sudden death in patients with moderate-to-severe heart fa ilure. Thus, the finding of asymptomatic NSVT on ambulatory ECG does not id entify specific candidates for antiarrhythmic or device therapy.