Electrophysiologic study: its predictive value for ventricular arrhythmias.
Studies have shown the predictive value of inducible ventricular tachycardia and clinical arrhythmia in patients who have structural heart disease. We examined the possible predictive value of electrophysiologic study before the placement of an implantable cardioverter-defibrillator. Our retrospective study group comprised 315 patients who had ventricular tachycardia that was inducible during electrophysiologic study and who had undergone at least 1 month of follow-up (247 men; mean age, 66.9 +/- 13.5 yr; mean follow-up, 24.9 +/- 14.8 mo). Recorded characteristics included induced ventricular tachycardia cycle length, atrio-His and His-ventricular electrograms, PR and QT intervals, QRS duration, and drug therapy. Of the 315 patients, 97 experienced ventricular arrhythmia during the follow-up period, as registered by 184 of more than 400 interrogations. There were 187 episodes of ventricular arrhythmia (tachycardia, 178; fibrillation, 9) during 652.5 person-years of follow-up. Subjects with a cycle length > or =240 msec were more likely to have an earlier 1st arrhythmia than those with a cycle length <240 msec (P=0.032). A quarter of the subjects with a cycle length > or =240 msec had their 1st arrhythmia by 19.14 months, compared with 23.8 months for a quarter of the subjects with a cycle length <240 msec (P <0.032). Among the electrophysiologic characteristics examined, inducible ventricular tachycardia with a cycle length > or =240 msec is predictive of appropriate implantable cardioverter-defibrillator therapy at an earlier time. This may have prognostic implications that warrant implantable cardioverter-defibrillator programming to enable appropriate antitachycardia pacing in this group of patients.
Gold
Daniel R
DR
Department of Cardiology, North Shore University Hospital, Manhasset, New York 11030, USA.
Catanzaro
John N
JN
Makaryus
John N
JN
Waldman
Cory
C
Sauer
William H
WH
Sison
Cristina
C
Makaryus
Amgad N
AN
Altman
Erik
E
Jadonath
Ram
R
Beldner
Stuart
S
D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006329:Heart Conduction System / Q000502:physiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009518:New York; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D016277:Ventricular Function, Left