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The aim of this study was to analyze the long-term clinical outcome of 60 prospectively studied patients with documented sustained ventricular tachyarrhythmia that was not inducible during baseline programmed ventricular stimulation: 39 with cardiac arrest due to noninfarction ventricular fibrillation (VF) and 21 with mild hemodynamically compromising sustained ventricular tachycardia (VT). Left ventricular ejection fraction was 55 [+ or -] 14% in the VF group and 50 [+ or -] 13% in the VT group (difference not significant). Patients were discharged without conventional antiarrhythmic drugs and received only empirical [beta]-blocker therapy. During a mean follow-up period of 21 [+ or -] 16 months (mean [+ or -] SD), 10 of 60 patients (17%) died suddenly. The actuarial incidence of sudden death at 1 and 4 years was similar in both groups (VF group, 10 and 20%; VT group, 16 and 16%) (p = 0.48). The actuarial incidence of sudden cardiac death was significantly higher in patients with left ventricular ejection fraction [is less than or equal to] 40% than in those with >40% (1-year incidence in VF group, 40 vs 0%; VT group, 50 vs 0%) (p = 0.005 and p = 0.01, respectively). Multivariate regression analysis identified left ventricular ejection fraction [is less than or equal to] 40% and previous myocardial infarction as the only independent predictor of sudden cardiac death. The occurrence of frequent ventricular pairs during Holter monitoring was the only independent predictor of sustained VT recurrences. It is concluded that patients with sustained ventricular tachyarrhythmia in whom arrhythmia was noninducible during baseline ventricular stimulation and not treated with antiarrhythmic therapy have a favorable outcome if left ventricular ejection fraction is high. However, reduced left ventricular ejection fraction identifies a subgroup at high risk of sudden cardiac death. Patients with mild hemodynamically compromising sustained VT have a similar risk of dying suddenly as those resuscitated earlier from cardiac arrest.

Of 150 consecutive patients with sustained monomorphic ventricular tachycardia (VT) (n = 116) or ventricular fibrillation (VF) (n = 34) late after acute myocardial infarction, 17 had reproduction of their sustained monomorphic VT during exercise testing. Data from these patients (group I) were compared with data from patients without exercise-induced VT (group II). No statistical difference was found between groups I and II with relation to age, sex, number of vessels with >70% stenosis, left ventricular ejection fraction, number of previous myocardial infarctions, inducibility during programmed stimulation and total mortality during follow-up. In group I, only 1 patient (60%) developed ST depression during exercise compared with 47 patients (35%) in group II (p

Seventeen patients with coronary artery disease, idiopathic dilated cardiomyopathy or no organic heart disease who presented with incessant ventricular tachycardia (VT) were studied and followed for a mean period of 51 [+ or -] 35 months. in these patients the incessant VT included [is greater than or equal to] 3 episodes of sustained VT at a rate of [is greater than or equal to] 120 beats/min and frequent episodes of nonsustained VT over a 24-hour period. No patient had electrolyte disorder, prolonged QT interval, drug-induced arrhythmia or myocardial infarction (Am J Cardiol 1990;66:831-836), Ventricular tachycardia (VT), a rapid heartbeat that originates in the contractile fibers of the ventricles, may cause sudden death. This abnormal rhythm must be suppressed immediately with anti-arrhythmic drugs. Because of the possibility of incessant (recurring) VT, physicians continue treatment even though these drugs have serious side effects, the most dangerous being proarrhythmia (worsening of the abnormal heart rhythm). Two anti-arrhythmic agents, flecainide and encainide, have been associated with increased mortality. Side effects, such as dizziness and palpitations, tend to worsen over time, and treatment is sometimes terminated when they become intolerable. The authors monitored 17 patients who met stringent criteria for a diagnosis of incessant VT. Six of the patients died; four from sudden death and two from heart attack. Anti-arrhythmic drugs were discontinued by six patients, five of whom remained in remission during the follow-up period. Three of these patients were found to be in remission one week after incessant VT was diagnosed; a fourth patient discontinued anti-arrhythmic medication because of pregnancy; and the fifth patient discontinued therapy after developing symptoms of congestive heart failure. On that basis, attempts were made to discontinue anti-arrhythmic treatment in the remaining five patients; four achieved remission of incessant VT. Nine of the 11 surviving patients, most of whom had previous episodes of ventricular arrhythmia, went into remission during the follow-up period. It is possible that some patients went into remission much earlier than when the drugs were discontinued. In these cases, suppression of the incessant VT was attributed to the anti-arrhythmic agent. A strong case can be made for attempting to terminate treatment. In addition to the serious side effects, the price of these drugs, and the frequent medical visits and tests are a considerable burden on patients. Based on this study of a small group of patients with incessant VT, termination of anti-arrhythmic treatment should be considered. A trial discontinuation should be conducted in a hospital setting where patients can be monitored, and close out-patient follow-up should be maintained during anti-arrhythmic treatment. Patients with a short history of ventricular arrhythmia before the onset of incessant VT seem to have a better chance of remission. (Consumer Summary produced by Reliance Medical Information, Inc.)

Marino Leonardi, MD(*) and Philip Varriale, MD. Division of Cardiology, Cabrini Medical Center, New York, NY. PURPOSE: A one year observational study of the causes of polymorphic ventricular tachycardia (PVT) [...]