Outcome of patients with nonsustained ventricular tachycardia and severely impaired ventricular function who have negative electrophysiologic studies.
Twenty-nine consecutive patients with a prior myocardial infarction, severely reduced left ventricular ejection fraction (26% +/- 8%), and asymptomatic nonsustained ventricular tachycardia were enrolled in a prospective trial. After a negative programmed electric stimulation study (3 extrastimuli at 2 sites with 2 drive trains), the 26 men and 3 women (mean age 71) were monitored for a mean of 13 months without antiarrhythmic drug therapy. Five patients died suddenly or had sustained ventricular tachycardia; three others had a cardiac, nonarrhythmic death. Events occurred in the first 13 months of the surveillance period. Clinical factors associated with a poor outcome included congestive heart failure and lack of beta-blocker therapy. In addition, patients with events tended to have lower ejection fractions than those without (21% vs 28%, p not significant). Thus a negative programmed electric stimulation study does not necessarily imply a benign outcome in patients with a prior infarction and nonsustained ventricular tachycardia if they also have severe left ventricular dysfunction and a history of heart failure. These data have important implications for the design and conduct of contemporary clinical trials.
Hernández
M
M
Division of Cardiovascular Diseases, Lankenau Hospital and Medical Research Center, Wynnewood, PA 19096.
Taylor
J
J
Marinchak
R
R
Rials
S
S
Rubin
A
A
Kowey
P
P
D000368:Aged; D018572:Disease-Free Survival; D004558:Electric Stimulation; D004594:Electrophysiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D011446:Prospective Studies; D013318:Stroke Volume; D016019:Survival Analysis; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000503:physiopathology*; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000503:physiopathology*