title: Usefulness of Holter monitoring in predicting efficacy of amiodarone therapy for sustained ventricular tachycardia associated with coronary artery disease.
abstract: The ability of Holter monitoring to predict clinical events during amiodarone therapy was evaluated in 83 patients with coronary artery disease and inducible monomorphic ventricular tachycardia. Sixty-four patients (77%) had significant ventricular ectopy activity (> or = 10 ventricular premature complexes [VPCs]/hour) at baseline, and 19 (23%) did not; patients were similar in age (63 and 65 years, respectively; p = 0.24) and ejection fraction (31 and 32%, respectively; p = 0.75). Over a mean of 23 +/- 17 months, there was no difference in arrhythmia recurrence (33 and 26%; p = 0.89) or sudden death (16 and 20%; p = 0.94) in patients with and without significant ectopy, respectively. In patients with significant ectopy, amiodarone decreased VPC frequency from baseline to 2 weeks, but not from 2 to 6 weeks. Forty-two patients had > 85% reduction in ectopy at 2 weeks; 20 patients did not. However, this reduction of simple VPCs did not predict a decrease in arrhythmic recurrence (29 vs 40%; p = 0.59) nor sudden death (25 vs 11%; p = 0.56) in patients with and without VPC suppression, respectively. Forty-five patients had Holter monitoring at 6 weeks. Twenty-one patients (47%) had > 95% suppression of ectopy, and 24 did not. Neither the recurrence (38 vs 38%; p = 0.54) nor sudden death (33 vs 13%; p = 0.45) rate was predicted by the degree of VPC suppression. Amiodarone is a powerful suppressant of VPCs, but Holter suppression of this ectopic activity is not predictive of clinical outcome.
authors.affiliation: Cardiac Electrophysiology Unit, Methodist Hospital, Houston, Texas 77030.
authors.forename: N
authors.initials: N
authors.lastname: Nasir
authors.forename: T K
authors.initials: TK
authors.lastname: Doyle
authors.forename: S H
authors.initials: SH
authors.lastname: Wheeler
authors.forename: A
authors.initials: A
authors.lastname: Pacifico
mesh_terms: D000206:Actuarial Analysis; D000638:Amiodarone / Q000627:therapeutic use*; D005117:Cardiac Complexes, Premature / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D003327:Coronary Disease / Q000150:complications*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012008:Recurrence; D017180:Tachycardia, Ventricular / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors
chemical_list: D000638:Amiodarone