Discordance between ambulatory monitoring and programmed stimulation in assessing efficacy of class IA antiarrhythmic agents in patients with ventricular tachycardia

Soo G. Kim, S. W. Seiden, J. A. Matos, L. E. Waspe, John Devens Fisher

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Abstract

Concordance between programmed stimulation and 24 hour ambulatory electrocardiographic (Holter) monitoring was studied in 54 patients with sustained ventricular tachycardia during 84 therapeutic trials with class IA antiarrhythmic agents. During baseline studies before treatment, all patients had frequent (≥ 30/h) ventricular premature complexes on Holter recordings and sustained ventricular tachycardia inducible by one to three extrastimuli. During treatment, programmed stimulation and Holter monitoring were repeated. Efficacy of treatment determined by programmed stimulation (ventricular tachycardia no longer inducible or nonsustained) was compared with three Holter criteria of efficacy: I = 83% or more reduction of ventricular premature complexes and abolition of ventricular tachycardia; II = 50% or more reduction of ventricular premature complexes and 90% or more reduction of couplets and abolition of ventricular tachycardia; III = abolition of ventricular tachycardia in patients with ventricular tachycardia during a baseline Holter recording. Treatments were judged effective by programmed stimulation criteria in only 25% of cases but in 51, 63 and 75% of cases by Holter criterion I, II and III, respectively. Results of programmed stimulation and Holter monitor were discordant (effective by one criterion but ineffective by the other) in 50% of cases using Holter criterion I, in 54% using Holter criterion II and in 61% using Holter criterion III. In the majority of discordant results, treatment appeared efficacious by Holter criteria but ineffective by programmed stimulation criteria, suggesting insensitivity of efficacy by Holter criteria or nonspecificity of induced ventricular tachyardia during treatment, or both. Conclusions: 1) programmed stimulation and Holter monitor recording are discordant in assessing efficacy of class IA antiarrhythmic agents; 2) efficacy by Holter criteria is often easier to achieve than efficacy by programmed stimulation (p < 0.001); and 3) the discordance between the two methods, both with very good reported predictive values, calls for long-term follow-up studies to determine sensitivity and specificity of each method.

Original languageEnglish (US)
Pages (from-to)539-544
Number of pages6
JournalJournal of the American College of Cardiology
Volume6
Issue number3
StatePublished - 1985

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Ambulatory Monitoring
Proxy
Ventricular Tachycardia
Ventricular Premature Complexes
Ambulatory Electrocardiography
Therapeutics
Sensitivity and Specificity

ASJC Scopus subject areas

  • Nursing(all)

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Discordance between ambulatory monitoring and programmed stimulation in assessing efficacy of class IA antiarrhythmic agents in patients with ventricular tachycardia. / Kim, Soo G.; Seiden, S. W.; Matos, J. A.; Waspe, L. E.; Fisher, John Devens.

In: Journal of the American College of Cardiology, Vol. 6, No. 3, 1985, p. 539-544.

Research output: Contribution to journalArticle

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abstract = "Concordance between programmed stimulation and 24 hour ambulatory electrocardiographic (Holter) monitoring was studied in 54 patients with sustained ventricular tachycardia during 84 therapeutic trials with class IA antiarrhythmic agents. During baseline studies before treatment, all patients had frequent (≥ 30/h) ventricular premature complexes on Holter recordings and sustained ventricular tachycardia inducible by one to three extrastimuli. During treatment, programmed stimulation and Holter monitoring were repeated. Efficacy of treatment determined by programmed stimulation (ventricular tachycardia no longer inducible or nonsustained) was compared with three Holter criteria of efficacy: I = 83{\%} or more reduction of ventricular premature complexes and abolition of ventricular tachycardia; II = 50{\%} or more reduction of ventricular premature complexes and 90{\%} or more reduction of couplets and abolition of ventricular tachycardia; III = abolition of ventricular tachycardia in patients with ventricular tachycardia during a baseline Holter recording. Treatments were judged effective by programmed stimulation criteria in only 25{\%} of cases but in 51, 63 and 75{\%} of cases by Holter criterion I, II and III, respectively. Results of programmed stimulation and Holter monitor were discordant (effective by one criterion but ineffective by the other) in 50{\%} of cases using Holter criterion I, in 54{\%} using Holter criterion II and in 61{\%} using Holter criterion III. In the majority of discordant results, treatment appeared efficacious by Holter criteria but ineffective by programmed stimulation criteria, suggesting insensitivity of efficacy by Holter criteria or nonspecificity of induced ventricular tachyardia during treatment, or both. Conclusions: 1) programmed stimulation and Holter monitor recording are discordant in assessing efficacy of class IA antiarrhythmic agents; 2) efficacy by Holter criteria is often easier to achieve than efficacy by programmed stimulation (p < 0.001); and 3) the discordance between the two methods, both with very good reported predictive values, calls for long-term follow-up studies to determine sensitivity and specificity of each method.",
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