Role of programmed ventricular stimulation and implantable cardioverter defibrillators in patients with idiopathic dilated cardiomyopathy and syncope

The aim of this study was to evaluate the role of programmed ventricular st imulation and ICDs in patients with idiopathic dilated cardiomyopathy and s yncope. Between 1990 and 1998, 54 (mean age 67 +/- 11 years, 76% men) patie nts presented with idiopathic dilated cardiomyopathy and syncope. An electr ophysiological study was done in 37 of the 54 patients: 10 had inducible su stained monomorphic ventricular tachycardia, 12 had conduction system disea se or neurocardiogenic syncope, and 15 had a normal study. Overall, 17 pati ents received an ICD, 15 patients received a pacemaker, and 22 patients rec eived no device. Nine of the 15 patients with a negative electrophysiologic al study eventually received an ICD: 3 because they were considered high ri sk and 6 because of recurrent syncope or presyncope. In the 17 patients who received an ICD, incidence of appropriate shocks at 1 and 3 years was 47% and 74%, respectively, in the inducible sustained monomorphic ventricular t achycardia group, and 40% and 40%, respectively, in the group without induc ible sustained monomorphic ventricular tachycardia (P = 0.29, log-rank test ). In conclusion, programmed ventricular stimulation is not useful in risk stratification of patients with idiopathic dilated cardiomyopathy and synco pe and may delay necessary ICD implantation.