The prognostic value of the changes in the mode of ventricular tachycardia induction noted during therapy with a marked reduction of ventricular ectopic activity

Soo G. Kim, Samuel D. Felder, Steven W. Seiden, Lawrence E. Waspe, John Devens Fisher

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Abstract

The prognostic significance of changes in the mode of induction of ventricular tachycardia (VT) noted during therapy was studied in 49 patients with sustained VT or ventricular fibrillation. Before treatment, all patients had inducible sustained VT by programmed stimulation (one to three extrastimuli) and frequent (≥30/hr) ventricular premature complexes (VPCs). On the discharge regimen, VT was no longer inducible by programmed stimulation in 22 patients (group 1). Twenty-seven patients (group 2) with persistent induction of VT despite extensive serial drug testings were discharged on a regimen that resulted in a marked reduction of VPCs on Holter monitoring (≥50% reduction of VPCs, ≥90% reduction of couplets, and abolition of nonsustained VT). The modes of induction at baseline and on the discharge regimen were compared in each patient in group 2. Induction of VT was more difficult, requiring more aggressive stimulation protocol in 5 of 27 patients, unchanged in 14 patients, and easier in 8 patients. The duration of follow-up was 20 ± 13 months (mean ± SD). Arrhythmia-free survival rates at 6, 12, 18, and 24 months were 95%, 89%, 82%, and 73% in group 1, 92%, 84%, 75%, and 75% in group 2, 93%, 83%, 77%, and 69% in 27 patients with noninducibility or harder induction, and 95%, 90%, 79%, and 79% in 22 patients with the same or easier induction, respectively. The differences were not significant. This nonrandomized study suggests that in selected patients with recurrent VT and frequent VPCs at baseline, changes in the mode of induction of VT (noninducible vs inducible; harder vs not harder) noted during therapy may not have prognostic significance if the therapy is accompanied by a marked reduction of VPCs. Randomized studies should be done to validate the results of this study.

Original languageEnglish (US)
Pages (from-to)1138-1145
Number of pages8
JournalAmerican Heart Journal
Volume114
Issue number5
DOIs
StatePublished - 1987

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Ventricular Tachycardia
Ventricular Premature Complexes
Therapeutics
Ambulatory Electrocardiography
Ventricular Fibrillation
Cardiac Arrhythmias
Survival Rate

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

The prognostic value of the changes in the mode of ventricular tachycardia induction noted during therapy with a marked reduction of ventricular ectopic activity. / Kim, Soo G.; Felder, Samuel D.; Seiden, Steven W.; Waspe, Lawrence E.; Fisher, John Devens.

In: American Heart Journal, Vol. 114, No. 5, 1987, p. 1138-1145.

Research output: Contribution to journalArticle

Kim, Soo G. ; Felder, Samuel D. ; Seiden, Steven W. ; Waspe, Lawrence E. ; Fisher, John Devens. / The prognostic value of the changes in the mode of ventricular tachycardia induction noted during therapy with a marked reduction of ventricular ectopic activity. In: American Heart Journal. 1987 ; Vol. 114, No. 5. pp. 1138-1145.
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abstract = "The prognostic significance of changes in the mode of induction of ventricular tachycardia (VT) noted during therapy was studied in 49 patients with sustained VT or ventricular fibrillation. Before treatment, all patients had inducible sustained VT by programmed stimulation (one to three extrastimuli) and frequent (≥30/hr) ventricular premature complexes (VPCs). On the discharge regimen, VT was no longer inducible by programmed stimulation in 22 patients (group 1). Twenty-seven patients (group 2) with persistent induction of VT despite extensive serial drug testings were discharged on a regimen that resulted in a marked reduction of VPCs on Holter monitoring (≥50{\%} reduction of VPCs, ≥90{\%} reduction of couplets, and abolition of nonsustained VT). The modes of induction at baseline and on the discharge regimen were compared in each patient in group 2. Induction of VT was more difficult, requiring more aggressive stimulation protocol in 5 of 27 patients, unchanged in 14 patients, and easier in 8 patients. The duration of follow-up was 20 ± 13 months (mean ± SD). Arrhythmia-free survival rates at 6, 12, 18, and 24 months were 95{\%}, 89{\%}, 82{\%}, and 73{\%} in group 1, 92{\%}, 84{\%}, 75{\%}, and 75{\%} in group 2, 93{\%}, 83{\%}, 77{\%}, and 69{\%} in 27 patients with noninducibility or harder induction, and 95{\%}, 90{\%}, 79{\%}, and 79{\%} in 22 patients with the same or easier induction, respectively. The differences were not significant. This nonrandomized study suggests that in selected patients with recurrent VT and frequent VPCs at baseline, changes in the mode of induction of VT (noninducible vs inducible; harder vs not harder) noted during therapy may not have prognostic significance if the therapy is accompanied by a marked reduction of VPCs. Randomized studies should be done to validate the results of this study.",
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