Programmed Ventricular Stimulation for Risk Stratification in Nonischemic Cardiomyopathy With Preserved or Mildly Reduced LVEF

doi:10.1016/j.jacep.2026.08.011

Arrhythmias & electrophysiologyResearch article

Programmed Ventricular Stimulation for Risk Stratification in Nonischemic Cardiomyopathy With Preserved or Mildly Reduced Left Ventricular Ejection Fraction (LVEF)

JACC Clin ElectrophysiolPublished 23 Sep 2026

Consecutive patients ... who underwent programmed ventricular stimulation (PVS) at a tertiary center (2014-2025)

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Authors' conclusion

PVS represents a useful tool for risk stratification of arrhythmic events in patients with NICM, myocardial scar and preserved or mildly reduced LVEF, identifying those who may benefit from primary prevention ICD implant.

Study context

Population: Patients with nonischemic cardiomyopathy (NICM), LVEF ≥40%, late gadolinium enhancement on cardiac magnetic resonance, and frequent premature ventricular complexes (PVCs; >5%) or nonsustained ventricular tachycardia who underwent PVSmedian aged 62 years, 33% women
Participants: 182 patients

Comparison: PVS-positive vs PVS-negative patients
PVS-positiven = 45
PVS-negativen = 137
Outcome: Major arrhythmic event (MAE): sustained ventricular tachycardia/fibrillation, appropriate implantable cardioverter-defibrillator (ICD) therapy, or sudden cardiac death
Follow-up: median 3.5-year follow-up

Main finding

As reported in the abstract

PVS-positive29%13 of 45 of 45

PVS-negative1.5%2 of 137 of 137

P < 0.001

Negative predictive value: 98.5%

Further findings

Additional major arrhythmic event (MAE) predictors

Multifocal PVCs/nonsustained ventricular tachycardia HR (95% CI): 6.6 (1.8-24.4)
Family history of sudden cardiac death HR (95% CI): 16.7 (4.5-62.3)
QRS ≥100 milliseconds HR (95% CI): 5.2 (1.4-19.2)
LVEF ≤50% HR (95% CI): 4.4 (1.4-13.4)

all P < 0.05

Noninvasive risk score incorporating these 4 variables

Optimism-corrected C-statistic (95% CI): 0.892 (0.805-0.957)

PVS positivity

PVS positive: 45 (25%)

Original publication

Programmed Ventricular Stimulation for Risk Stratification in Nonischemic Cardiomyopathy With Preserved or Mildly Reduced LVEF. JACC Clin Electrophysiol. Published 23 September 2026. doi:10.1016/j.jacep.2026.08.011

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Summarised from the published abstract; every number is checked against it