title: Prospective detection of vulnerability to sustained ventricular tachycardia in patients awaiting cardiac transplantation.
abstract: This prospective study tested the hypothesis that abnormal signal-averaged electrocardiograms (ECGs) and inducible ventricular arrhythmias identify patients awaiting cardiac transplantation who are prone to sustained ventricular tachycardia (VT) or ventricular fibrillation (VF). Thirty-seven patients with advanced symptoms of heart failure and a mean left ventricular ejection fraction of 20 +/- 7 were studied. In response to programmed ventricular stimulation using up to 3 extrastimuli, sustained monomorphic VT was induced in 8 (22%) and polymorphic VT or VF was induced in 5 patients (13%). Patients with inducible arrhythmias underwent drug therapy guided by results of programmed ventricular stimulation or implantation of a defibrillator. Patients in whom ventricular arrhythmias could not be induced were not treated for arrhythmias. The signal-averaged ECG was abnormal and sustained VT or VF was induced in 10 patients (27%). Follow-up ranged from 1 to 33 months (mean 12). Four patients (11%) died suddenly and 4 (11%) had nonfatal sustained VT or VF. The positive predictive value for sudden death or nonfatal VT/VF was 27% for the signal-averaged ECG, 38% for programmed ventricular stimulation, and 50% if both tests were abnormal. The negative predictive values for these tests were 87, 88 and 88%, respectively. The actuarial incidence of arrhythmic events was significantly higher in patients with inducible ventricular arrhythmias (p = 0.017) and in patients in whom both the results of signal-averaged electrocardiographic analysis and the response to programmed ventricular stimulation were abnormal (p = 0.002). This study demonstrates that results of signal-averaged electrocardiographic analysis and the response to programmed ventricular stimulation improve risk stratification for sudden cardiac death in patients awaiting cardiac transplantation.
authors.affiliation: Cardiology Division, Washington University School of Medicine, St. Louis, Missouri 63110.
authors.forename: B D
authors.initials: BD
authors.lastname: Lindsay
authors.forename: J L
authors.initials: JL
authors.lastname: Osborn
authors.forename: K B
authors.initials: KB
authors.lastname: Schechtman
authors.forename: J L
authors.initials: JL
authors.lastname: Kenzora
authors.forename: H D
authors.initials: HD
authors.lastname: Ambos
authors.forename: M E
authors.initials: ME
authors.lastname: Cain
mesh_terms: D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D002303:Cardiac Output, Low / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012306:Risk; D012815:Signal Processing, Computer-Assisted; D013610:Tachycardia / Q000517:prevention & control*; D014693:Ventricular Fibrillation / Q000517:prevention & control*