Inducibility of ventricular tachycardia or fibrillation during programmed electrical stimulation predicted a significantly higher incidence of sustained VT or sudden death (31.5% vs 2%; p<0.001).
Cohort (n=73)
Randomly assigned (for a subgroup)
Does programmed electrical stimulation predict sustained VT or sudden death in patients with high-grade ventricular premature beats without prior sustained VT or syncope?
Programmed electrical stimulation can identify a high-risk subgroup for sustained VT and sudden death among patients with high-grade ventricular ectopy but no prior sustained arrhythmias.
Absolute Event Rate: 31.5% vs 2%
p-value: p=<0.001
The significance and treatment of ventricular premature beats (VPBs) in patients without sustained ventricular tachycardia (VT), sudden death, or syncope remains unclear. We undertook a prospective study of programmed electrical stimulation (up to two extrastimuli and burst pacing) in 73 patients (age 60 +/- 10 years) with high-grade VPBs who had no evidence of sustained VT, sudden death, or syncope as determined by 48 hr of monitoring in the cardiac care unit and 48 hr Holter monitoring. Fifty-six patients (76.7%) had atherosclerotic heart disease, 10 (13.7%) had cardiomyopathy or valvular heart disease, and seven (9.6%) had no evident heart disease. Thirty-seven patients (50.7%) had Lown grade IVB VPBs, 30 (41.1%) had Lown grade IVA VPBs, and six (8.2%) had Lown grade III VPBs. Programmed electrical stimulation identified two groups of subjects: group 1 comprised 20 patients (27%) in whom VT or ventricular fibrillation was induced, group 2 comprised 53 patients (73%) in whom no ventricular arrhythmia or only two to four repetitive ventricular responses were induced. There was a significant difference between the presence of atherosclerotic heart disease, old myocardial infarction, and ejection fraction of less than 40% in group 1 compared with group 2. However, there was no significant difference in the grade of VPBs between the two groups. Seventeen of 20 patients from group 1 were placed on antiarrhythmic therapy (defined by programmed electrical stimulation), whereas group 2 patients were randomly assigned to prophylactic antiarrhythmic therapy. A total of 70 patients were followed up for 30 +/- 15 months. The incidence of sustained VT and/or sudden death (31.5% vs 2%; p less than .001) was significantly higher in group 1 compared with group 2.(ABSTRACT TRUNCATED AT 250 WORDS)
Gomes et al. (1984) conducted a cohort in High-grade ventricular ectopy (n=73). Programmed electrical stimulation (inducibility of VT/VF) vs. Non-inducibility of VT/VF was evaluated on Sustained VT and/or sudden death (p=<0.001). Inducibility of ventricular tachycardia or fibrillation during programmed electrical stimulation predicted a significantly higher incidence of sustained VT or sudden death (31.5% vs 2%; p<0.001).