Factors determining programmed stimulation responses and long-term arrhythmic outcome in survivors of ventricular fibrillation with ischemic heart disease.
The clinical and angiographic features of 38 patients with ischemic heart disease and nonacute infarction pre-hospital ventricular fibrillation (VF) were examined as a function of their drug-free programmed electrical stimulation (PES) responses. Twenty-two patients (58%) had inducible ventricular tachycardia (VT) at drug-free PES (group I) and 16 patients (42%) did not (group II). Group I had more patients with: (1) remote infarction (22 of 22 vs 2 of 16; p less than 0.01; (2) history of congestive failure (16 of 22 vs 0 of 16; p less than 0.01); (3) prior cardiac arrest (11 of 22 vs 0 of 16; p less than 0.01); (4) left ventricular (LV) ejection fraction less than 40% (19 of 22 vs 1 of 16; p less than 0.01); and (5) akinetic or dyskinetic LV wall motion (22 of 22 vs 2 of 16; p less than 0.001). Group II had more patients with: (1) LV segments at "ischemic jeopardy" (16 of 16 vs 14 of 22; p less than 0.01) and (2) factors suggestive of ischemia at the onset of VF (13 of 16 vs 1 of 22; p less than 0.001). Inducible VT (IVT) was suppressed in 16 of the 20 group I patients surviving hospitalization while four were discharged with persistence of IVT despite therapy. At 27 +/- 15 months, all four with persistent IVT had a recurrence of their arrhythmia. In the 16 group II patients, therapy was limited to antiischemic measures: coronary bypass in 12, propranolol in 3, and angioplasty in one. At 38 +/- 9 months, no group II patient has had a recurrence of his arrhythmia.(ABSTRACT TRUNCATED AT 250 WORDS)
Kehoe
R
R
Department of Medicine, Northwestern University School of Medicine.
Tommaso
C
C
Zheutlin
T
T
Meyers
S
S
Mattioni
T
T
Dunnington
C
C
Lesch
M
M
D000787:Angina Pectoris / Q000503:physiopathology; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D002304:Cardiac Pacing, Artificial; D017023:Coronary Angiography; D003327:Coronary Disease / Q000150:complications* / Q000000981:diagnostic imaging; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D011379:Prognosis; D013318:Stroke Volume; D014693:Ventricular Fibrillation / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology
D000889:Anti-Arrhythmia Agents