title: Induction of ventricular fibrillation predicts sudden death in patients treated with amiodarone because of ventricular tachyarrhythmias after a myocardial infarction.
abstract: OBJECTIVE
  To examine the value of programmed electrical stimulation of the heart in predicting sudden death in patients receiving amiodarone to treat ventricular tachyarrhythmias after myocardial infarction.
  
  
  METHODS
  Consecutive patients; retrospective study.
  
  
  METHODS
  Referral centre for cardiology, academic hospital.
  
  
  METHODS
  106 patients with ventricular tachycardia (n = 77) or ventricular fibrillation (n = 29) late after myocardial infarction.
  
  
  METHODS
  Programmed electrical stimulation was performed while on amiodarone treatment for at least one month.
  
  
  RESULTS
  In 80/106 patients either ventricular fibrillation (n = 15) or sustained monomorphic ventricular tachycardia (n = 65) was induced. After a mean follow up of 50 (SD 40) months (1-144), 11 patients died suddenly and two used their implantable cardioverter debfibrillator. By multivariate analysis two predictors for sudden death were found: (1) inducibility of ventricular fibrillation under amiodarone treatment (P << 0.001), and (2) a left ventricular ejection fraction of < 40% (P < 0.05). The survival rate at one, two, three, and five years was 70%, 62%, 62%, and 40% respectively for patients in whom ventricular fibrillation was induced, and 98%, 96%, 94%, 94% for patients with induced sustained monomorphic ventricular tachycardia. Where there was no sustained arrhythmia, five year survival was 100%.
  
  
  CONCLUSIONS
  In patients receiving amiodarone because of life threatening ventricular arrhythmias after myocardial infarction, inducibility of ventricular fibrillation, but not of sustained monomorphic ventricular tachycardia, indicates a high risk of sudden death.
authors.affiliation: Department of Cardiology, University of Limburg, Academic Hospital, Maastricht, The Netherlands.
authors.forename: L M
authors.initials: LM
authors.lastname: Rodríguez
authors.forename: E B
authors.initials: EB
authors.lastname: Sternick
authors.forename: J L
authors.initials: JL
authors.lastname: Smeets
authors.forename: C
authors.initials: C
authors.lastname: Timmermans
authors.forename: K
authors.initials: K
authors.lastname: den Dulk
authors.forename: G
authors.initials: G
authors.lastname: Oreto
authors.forename: H J
authors.initials: HJ
authors.lastname: Wellens
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000638:Amiodarone / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects*; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014693:Ventricular Fibrillation / Q000209:etiology* / Q000628:therapy
chemical_list: D000889:Anti-Arrhythmia Agents; D000638:Amiodarone