Determinants of survival in patients with malignant ventricular arrhythmia associated with coronary artery disease.
The long-term survival data in patients with coronary artery disease and a history of malignant ventricular arrhythmia, defined as noninfarction ventricular fibrillation (VF) or hemodynamically compromising ventricular tachycardia (VT) followed for up to 9 years, were analyzed. In this group of 161 patients there was a total of 57 deaths, of which 35 (63%) were sudden. Life-table analysis demonstrated a 10% sudden death rate for all patients in the first year and a 7% annual rate in the subsequent 4 years. In patients managed noninvasively, the overall mortality rate was 27% over 9 years, or 3% per year. Suppression of ventricular tachycardia on both ambulatory monitoring and exercise testing was associated with improved survival. In patients evaluated by electrophysiologic testing the sudden death rate was 1.4% per year over an average of 5 years. This survival rate was not different compared with the noninvasive group (p = 0.09). Measures of left ventricular dysfunction and the frequency of ventricular arrhythmia before and after drug therapy were associated with a risk of sudden cardiac death by univariate analysis. Multivariate regression analysis identified 4 variables as independent predictors of sudden cardiac death: rales (p = 0.009), the number of runs of VT during exercise testing while receiving antiarrhythmic drug therapy (p = 0.0003), a history of congestive heart failure (p = 0.0009) and the number of premature beats on Holter monitoring (p = 0.01). These findings support the concept that suppression of repetitive arrhythmia on Holter monitor and exercise testing is a marker for improved survival among patients with malignant ventricular arrhythmia.(ABSTRACT TRUNCATED AT 250 WORDS)
Lampert
S
S
Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115.
Lown
B
B
Graboys
T B
TB
Podrid
P J
PJ
Blatt
C M
CM
D000206:Actuarial Analysis; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D003327:Coronary Disease / Q000150:complications*; D003645:Death, Sudden / Q000209:etiology; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D013610:Tachycardia / Q000209:etiology / Q000401:mortality*; D014693:Ventricular Fibrillation / Q000209:etiology / Q000401:mortality*
D000889:Anti-Arrhythmia Agents