Results of electrophysiologic testing and long-term prognosis in patients with coronary artery disease and aborted sudden death.
The purpose of this study was to evaluate the results of electrophysiologic testing and the long-term prognosis of 56 patients with coronary artery disease who presented with aborted sudden death unrelated to acute myocardial infarction. The mean age of the patients was 62 +/- 8 years (+/- standard deviation) and 48 were men. The mean left ventricular ejection fraction was 0.34 +/- 0.16. During the baseline electrophysiology test, sustained monomorphic ventricular tachycardia (VT) was inducible in 22 patients who then underwent electropharmacologic testing: 11 patients were treated with antiarrhythmic drugs that suppressed the induction of VT or resulted in the VT becoming hemodynamically stable; 10 patients who failed drug testing received an automatic implantable cardioverter/defibrillator (AICD); one patient underwent endocardial resection. Among 34 patients who did not have inducible sustained VT, a precipitant of cardiac arrest (severe ischemia, proarrhythmia) was identified and was corrected in 9 of 34. An AICD was recommended in the remaining 25 patients; however, nine patients refused and were treated empirically with antiarrhythmic drugs. The mean follow-up was 22 +/- 12 months. The 2-year actuarial incidence of sudden death was 31% in patients who were treated with drugs based on the results of electropharmacologic testing, 26% in patients who were treated with antiarrhythmic drugs on an empiric basis, 0% among patients in whom a correctable etiology for the cardiac arrest was identified, and 9% among patients who underwent implantation of an AICD. The 3-year actuarial incidence of sudden death among the 20 patients treated with antiarrhythmic drugs was 53%, compared with 9% among the 26 patients who underwent AICD implantation (p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0022.
J
J
Sousa
S
S
Rosenheck
H
H
Calkins
M
M
de Buitleir
S
S
Schmaltz
A
A
Kadish
F
F
Morady
D000206:Actuarial Analysis; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003327:Coronary Disease / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D004554:Electric Countershock; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D019736:Prostheses and Implants; D012044:Regression Analysis; D015996:Survival Rate; D013610:Tachycardia / Q000503:physiopathology; D013997:Time Factors
D000889:Anti-Arrhythmia Agents