Ventricular tachyarrhythmia detection by implantable loop recording in patients with heart failure and preserved ejection fraction: the VIP‐HF study

AIMS: The primary aim of the VIP‐HF study was to examine the incidence of sustained ventricular tachyarrhythmias (VTs) in heart failure (HF) with mid‐range (HFmrEF) or preserved ejection fraction (HFpEF). Secondary aims were to examine the incidence of non‐sustained VTs, bradyarrhythmias, HF hospitalizations and mortality. METHODS AND RESULTS: This was an investigator‐initiated, prospective, multicentre, observational study of patients with HF and left ventricular ejection fraction (LVEF) >40%. Patients underwent extensive phenotyping, after which an implantable loop recorder was implanted. We enrolled 113 of the planned 250 patients [mean age 73 ± 8 years, 51% women, New York Heart Association class II/III 54%/46%, median N‐terminal pro B‐type natriuretic peptide 1367 (710–2452) pg/mL and mean LVEF 54 ± 6%; 75% had LVEF >50%]. Eighteen percent had non‐sustained VTs and 37% had atrial fibrillation on Holter monitoring. During a median follow‐up of 657 (219–748) days, the primary endpoint of sustained VT was observed in one patient. The incidence of the primary endpoint was 0.6 (95% confidence interval 0.2–3.5) per 100 person‐years. The incidence of the secondary endpoint of non‐sustained VT was 11.5 (7.1–18.7) per 100 person‐years. Five patients developed bradyarrhythmias [3.2 (1.4–7.5) per 100 person‐years], three were implanted with a pacemaker. In total, 23 patients (20%) were hospitalized for HF [16.3 (10.9–24.4) per 100 person‐years]. Fourteen patients (12%) died [8.7 (5.2–14.7) per 100 person‐years]; 10 due to cardiovascular causes, and four sudden deaths, one with implantable loop recorder‐confirmed bradyarrhythmias as terminal event, three others undetermined. CONCLUSION: Despite the lower than expected number of included patients, the incidence of sustained VTs in HFmrEF/HFpEF was low. Clinically relevant bradyarrhythmias were more often observed than expected.