PATIENTS WITH VALVULAR HEART-DISEASE PRESENTING WITH SUSTAINED VENTRICULAR TACHYARRHYTHMIAS OR SYNCOPE - RESULTS OF PROGRAMMED VENTRICULAR STIMULATION AND LONG-TERM FOLLOW-UP
A. Martinezrubio et al., PATIENTS WITH VALVULAR HEART-DISEASE PRESENTING WITH SUSTAINED VENTRICULAR TACHYARRHYTHMIAS OR SYNCOPE - RESULTS OF PROGRAMMED VENTRICULAR STIMULATION AND LONG-TERM FOLLOW-UP, Circulation, 96(2), 1997, pp. 500-508
Background Programmed ventricular stimulation is commonly used to guid
e therapy in post-myocardial infarction patients with sustained monomo
rphic ventricular tachycardia (VT) or ventricular fibrillation (VF). I
n patients with valvular heart disease presenting with spontaneous VT,
VF, or syncope, the usefulness of this technique is still unclear. Th
e aim of the study was to analyze whether programmed ventricular stimu
lation was helpful in guiding therapy and determining prognosis in 97
patients with valvular heart disease presenting with VT (60%), VF (18%
), or syncope (22%). Methods and Results Patients were classified as h
aving either predominant ventricular pressure or volume overload or no
significant pressure or volume overload. Overall, sustained VT or VF
was inducible in 38 (39%) and 19 (20%) patients, respectively. Forty-s
ix (47%) patients were discharged on antiarrhythmic drugs, 29 (30%) re
ceived an implantable cardioverter-defibrillator, and 22 (23%) remaine
d without therapy. With serial drug testing, inducibility was complete
ly or partially suppressed in 18 (19%) and 9 (9%) patients, respective
ly. During a mean follow-up of 51 months (n=97), 17 patients (18%) die
d (sudden death, n=7; heart failure, n=4; noncardiac causes, n=6). One
-, 2- and 3-year event-free survival for sudden death, sustained VT, o
r VF was 77%, 68%, and 61%, respectively. Only inducibility of VT duri
ng baseline study (P<.0003) and left ventricular volume overload (P<.0
08) were significant predictors of arrhythmic events. Recurrence of ar
rhythmic events occurred in 56% and 56% of patients with complete or p
artial suppression of inducibility during serial drug testing as well
as in 10 of 19 (53%) patients without a change in inducibility. Conclu
sions Although programmed ventricular stimulation seems to predict adv
erse outcome, serial drug testing is unreliable in guiding therapy. Th
e type of workload imposed on the ventricles influences outcome, being
worse in patients with left ventricular volume overload. Therefore, i
mplantation of a cardioverter-defibrillator should be considered early
for the management of these patients.