Patients with heart failure and a preserved left ventricular ejection fraction (HFpEF) have a grim prognosis, with less than 50% of patients still alive after five years. An important mode of death is sudden death, accounting for up to 30% of all deaths in this population. Until recently, it was unknown whether ventricular tachyarrhythmias were the cause of these sudden deaths. The VIP-HF study was designed to examine the incidence of sustained ventricular tachyarrhythmias in patients with HFpEF. For this purpose, patients were implanted with an implantable loop recorder. This device is placed under the skin, and can record the heart rhythm continuously for up to two years.
In the VIP-HF, it was observed that the incidence of sustained ventricular tachyarrhythmias was low, occurring in only 1 patient (0.6 events per 100 person years) during a median of 1.8 years of follow-up. In contrast; bradyarrhythmias were more frequently observed, namely in 5 patients (3.2 events per 100 person years), of whom 3 needed pacemaker therapy. Overall hospitalisations for heart failure and mortality were high (16.3 and 8.7 events per 100 person years, respectively.)
In conclusion, the VIP-HF study reports a low incidence of sustained ventricular tachyarrhythmias in patients with heart failure with preserved- or mildly reduced ejection fraction, 10-times lower than anticipated. In contrast, clinically relevant bradyarrhythmias were more often observed than expected. This finding was also highlighted in the editorial comment written by Luanda Grazette and Jeffrey Goldberger, who suggested that the high incidence of bradyarrhythmias may be associated with the use of beta-blockers in patients with HFpEF.
Earlier this year, the VIP-HF study was presented by Michiel Rienstra and Gijs van Woerden at the HFA Discoveries and was accepted for publication in the European Journal of Heart Failure on 19 July 2020.
View the article and its related editorial comment on the website of the European Journal of Heart Failure:
Vanessa P.M. van Empel (MUMC+)
Olivier C. Manintveld (ErasmusMC)
Robert G. Tieleman (Martini ziekenhuis)
Kevin Vernooy (MUMC+)