Comparative follow up of patients with implanted cardioverter-defibrillators after induction of sustained monomorphic ventricular tachycardias or ventricular fibrillation by programmed stimulation.
OBJECTIVE
To investigate the prognostic value of induced monomorphic ventricular tachycardia (VT) and ventricular flutter or fibrillation (VF) during programmed electrical stimulation in patients with a high risk for sudden arrhythmogenic cardiac death.


METHODS
Prospective cohort study.


METHODS
102 patients at high risk for arrhythmogenic sudden cardiac death who received an automated implantable cardioverter-defibrillator (AICD) were evaluated. 56 patients received the AICD for primary prevention and 46 for secondary prevention. 58 patients had induction of a monomorphic VT (VT group) and 44 had induction of a polymorphic VT, ventricular flutter, or ventricular fibrillation (VF group) during programmed electrical stimulation. Average follow up was 20 months in both groups.


METHODS
Appropriate AICD protocol.


RESULTS
In patients who received the AICD for primary prevention, 16 of 32 patients in the VT group, compared with only four of 24 patients in the VF group, received an appropriate AICD protocol (p = 0.02). In the entire study population, 479 appropriate AICD protocols were recorded in 28 (48%) patients in the VT group and 28 appropriate protocols in 11 (25%) patients in the VF group. Cumulative Kaplan-Meier event-free survival curves were significantly different (p = 0.02).


CONCLUSIONS
Induction of VF during programmed electrical stimulation is of no prognostic value even in high risk patients without previously documented ventricular fibrillation.
Meyborg
M
M
Klinikum der Universität Heidelberg, Innere Medizin III, Bergheimer Strasse 58, D-69115 Heidelberg, Germany.
Mura
R
R
Tiefenbacher
C
C
Becker
R
R
Michaelsen
J
J
Niroomand
F
F
D000368:Aged; D002985:Clinical Protocols; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004599:Electric Stimulation Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D017180:Tachycardia, Ventricular / Q000628:therapy*; D014693:Ventricular Fibrillation / Q000628:therapy*