title: Value of programmed ventricular stimulation in patients with congenital heart disease.
abstract: 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.
authors.affiliation: Department of Cardiology, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. MarkA@cardio.tch.harvard.edu
authors.forename: M E
authors.initials: ME
authors.lastname: Alexander
authors.forename: E P
authors.initials: EP
authors.lastname: Walsh
authors.forename: J P
authors.initials: JP
authors.lastname: Saul
authors.forename: M R
authors.initials: MR
authors.lastname: Epstein
authors.forename: J K
authors.initials: JK
authors.lastname: Triedman
mesh_terms: 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