title: Different predictive values of electrophysiological testing and autonomic assessment in patients surviving a sustained arrhythmic episode.
abstract: BACKGROUND
  Recent data suggest that the electrophysiological study (EPS) has limited value in the identification of high risk patients, so the aim of the present study was to evaluate if non-invasive measurement of baroreflex sensitivity (BRS), a marker of autonomic balance, provides additional prognostic information in patients surviving a sustained arrhythmic episode.
  
  
  RESULTS
  The study group comprised 112 post myocardial infarction patients consecutively referred for EPS following documented ventricular fibrillation (VF) (20), sustained ventricular tachycardia (VT) (74) or a syncopal episode with subsequently documented non-sustained VT at Holter monitoring (18). BRS was assessed according to the transfer function method. A cardioverter - defibrillator (ICD) was implanted in 97 patients. During follow-up (median 315 days), appropriate ICD discharge occurred in 53 patients, and 3 more patients died suddenly. Sustained VT was induced in 84% and 77% of patients who did or did not develop arrhythmia at follow-up (p=0.34). No differences were found in age, sex, infarct site, drug therapy, resting RR interval or cycle of induced VT. Left ventricular ejection fraction (LVEF) < or =35%, New York Heart Association (NYHA) class >2 and BRS < or =3.3 ms/mmHg were found to be univariate predictors of arrhythmia recurrence. Multivariate models were obtained after grouping patients according to a moderately or severely depressed LVEF. Among the patients with LVEF < or =35%, BRS < or =3.3 ms/mmHg emerged as the only significant risk predictor of arrhythmia occurrence (sensitivity, specificity, positive and negative predictive value = 79%, 74%, 83% and 68%, respectively), whereas NYHA class >2 was a significant predictor among patients with LVEF >35%.
  
  
  CONCLUSIONS
  Noninvasive BRS, but not EPS, is of value in predicting VT/VF episode recurrence in patients surviving a major arrhythmic event.
authors.affiliation: II Department of Cardiology, Medical University of Gdańsk, Poland. gracz@amg.gda.pl
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Raczak
authors.forename: Gian Domenico
authors.initials: GD
authors.lastname: Pinna
authors.forename: Roberto
authors.initials: R
authors.lastname: Maestri
authors.forename: Ludmiła
authors.initials: L
authors.lastname: Daniłowicz-Szymanowicz
authors.forename: Małgorzta
authors.initials: M
authors.lastname: Szwoch
authors.forename: Andrzej
authors.initials: A
authors.lastname: Lubinski
authors.forename: Maciej
authors.initials: M
authors.lastname: Kempa
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: La Rovere
authors.forename: Grazyna
authors.initials: G
authors.lastname: Swiatecka
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology*; D017704:Baroreflex / Q000502:physiology; D016757:Death, Sudden, Cardiac; D004594:Electrophysiology / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016019:Survival Analysis
chemical_list: D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D000638:Amiodarone