[Value and limitations of Holter monitoring and electrophysiologic testing in the evaluation of the treatment of sustained monomorphic ventricular tachycardia].
The authors studied the value and limitations of Holter monitoring and electrophysiological investigation in the evaluation of treatment of sustained monomorphic ventricular tachycardia (VT). One hundred and twenty-four consecutive patients were included in the study from January 1981 to February 1988. The etiologies were chronic myocardial infarction (N = 54), dilated cardiomyopathy (N = 24), right ventricular dysplasia (N = 31), and idiopathic VT (N = 15). All the tachycardias could be induced during baseline electrophysiological investigations and presented as complex ventricular arrhythmias on the Holter recordings. The investigations were repeated after treatment which was maintained irrespective of the results, unless the tachycardia which was induced or recorded was over 130 cycles/min and/or poorly tolerated. Recurrence was defined as the recording of VT in the absence of a change of treatment and/or the occurrence of sudden death. The follow-up period averaged 29 +/- 21 months. The Kaplan-Meier method was used to study the prevalence of absence of recurrence and survival rates. We observed 28 recurrences of VT and there were 21 deaths. Eighty-five per cent of patients had normal Holter monitoring after treatment. The prevalence of absence of recurrence was 0.751 when the Holter was normal and 0.485 when an arrhythmia was recorded (p = 0.03). The sensitivity was 25 per cent and the specificity 88 per cent. The survival rates were 0.66 and 0.585 respectively (p = 0.008). Fifty-three per cent of patients remained inducible after treatment with a prevalence of absence of recurrence of 0.572. This value rose to 0.877 when VT could not be induced (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
Aouate
P
P
Service de cardiologie (rythmologie), hôpital Jean-Rostand, Ivry-sur-Seine.
Frank
R
R
Fontaine
G
G
Fillette
F
F
Rougier
I
I
Tonet
J
J
Grosgogeat
Y
Y
D000206:Actuarial Analysis; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D004452:Echocardiography; D004594:Electrophysiology; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D013318:Stroke Volume; D016019:Survival Analysis; D013610:Tachycardia / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy
Intérêts et limites de l'enregistrement Holter et de l'exploration électrophysiologique dans l'évaluation du traitement des tachycardies ventriculaires monomorphes soutenues.