Physicians' Academy for Cardiovascular Education

NT-proBNP predicts risk of incident ventricular arrhythmias in adults with an ICD

N-terminal pro-B-type natriuretic peptide for prediction of ventricular arrhythmias: Data from the SMASH study

Literature - Sourour N, Riveland E, Naesgaard P, et al. - Clin Cardiol. 2023 Jul 3. [Online ahead of print] doi: 10.1002/clc.24074

Introduction and methods


Predicting the risk of ventricular arrhythmia (VA) is challenging due to a large number of heart disease conditions that can result in VA and subsequently sudden cardiac death (SCD). Previous work demonstrated that NT-proBNP is associated with a higher risk of SCD in patients with chronic HF, ischemic heart disease, HCM, and in the general population [1-4]. However, it is unclear whether there is an association between NT-proBNP and incident VA.

Aim of the study

The study aim was to evaluate whether there is an association between NT-proBNP and device-recorded and adjudicated incident VA.



The authors performed the biomarker study of the SMASH (Scandinavian Multicenter study to Advance risk Stratification in Heart disease - ventricular arrhythmia) 1 trial. SMASH 1 was an prospective, observational, multicenter study that enrolled adults with an implantable cardioverter defibrillator (ICD) who had a life expectancy of >2 years. In this analysis, 490 patients were included. The mean time from ICD implantation to study inclusion was 5.1±6.6 years. 255 (52%) patients had a primary prevention ICD indication, whereas 135 (28%) patients had cardiac resynchronization therapy with ICD indication. The mean follow-up period was 3.10±0.74 years.


The primary outcome in the SMASH study was incident VA, defined as episodes of ventricular tachycardia (VT) or ventricular fibrillation (VF) resulting in appropriately delivered ICD therapies, namely, electrical shock or antitachycardia pacing, or sustained ventricular tachyarrhythmia (>100 b.p.m. and >30 s). Recorded VA events were adjudicated by experienced cardiac electrophysiologists who were blinded to NT-proBNP concentrations.

Main results


Higher NT-proBNP concentrations were associated with incident VA, independently of established risk factors for cardiac arrest. Serial measurements of NT-proBNP were not beneficial for arrhythmic risk stratification. The authors concluded “[o]ur data suggest that NT‐proBNP may be a helpful tool for assessing VA risk, particularly in patients with a secondary ICD indication.”.


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Find this article online at Clin Cardiol.

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