Value of programmed ventricular stimulation in patients with congenital heart disease.
BACKGROUND
The role of programmed ventricular stimulation (VSTIM) for risk stratification in congenital heart disease is unclear. We analyzed the results of VSTIM in selected congenital heart disease survivors at a single center to determine whether it improved the ability to predict a serious outcome.


RESULTS
Between July 1985 and September 1996, 140 primary VSTIM studies were performed on 130 patients (median age 18.1 years, range 0 to 51). Tetralogy of Fallot (33 %), d-transposition of the great arteries (25 %), and left ventricular outflow tract obstruction (12%) accounted for the majority of patients. Indications included spontaneous ventricular tachycardia (VT) of > or = 3 beats (72%) and/or symptoms (68%). Sustained VT was induced in 25% of the studies, and nonsustained VT in 12%. Atrial flutter or other supraventricular tachycardia was documented in 32% and bradyarrhythmias in 26%. By univariate analysis, mortality was increased in patients with positive VSTIM versus negative VSTIM (18% vs 7%, P = 0.04). Using multivariate analysis, positive VSTIM was associated with a sixfold increased risk of decreased survival and a threefold increased risk of serious arrhythmic events, allowing up to 87% sensitivity in predicting mortality. However, 7 (33%) of 21 patients with documented clinical VT had false-negative studies.


CONCLUSIONS
VSTIM in a large, selected group of congenital heart disease patients identified a subgroup with significantly increased mortality and sudden arrhythmic events. Failure to induce VT was a favorable prognostic sign, but the frequency of false-negative studies was high. Frequent supraventricular tachycardia further complicated risk stratification. Although VSTIM appears to be a reasonable tool for evaluation of this population, a larger, multicenter trial is recommended to clarify its utility.
Alexander
M E
ME
Department of Cardiology, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. MarkA@cardio.tch.harvard.edu
Walsh
E P
EP
Saul
J P
JP
Epstein
M R
MR
Triedman
J K
JK
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D004558:Electric Stimulation; D015716:Electrocardiography, Ambulatory; D005260:Female; D006327:Heart Block / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D006330:Heart Defects, Congenital / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013617:Tachycardia, Supraventricular / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality