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A post hospital follow-up system based on predetermined antiarrhythmic strategies and telephone transmitters used to record ECGs was helpful in managing post hospital course and improved survival in patients with a history of out-of-hospital sudden death. All patients underwent therapy guided by serial electrophysiologic testing. Of the 47 patients, 19 used the telephone transmitter system and 28 did not. During follow-up, residual symptomatic and silent ventricular arrhythmia was documented in 78% of patients using telephone transmitters. Ventricular tachycardia was transmitted in six patients--all survived. During an average 15-month follow-up, 1 of 19 patients using the telephone transmitter system died vs 12 deaths among the 28 patients who did not use the system (p less than 0.005). These results were independent of ejection fraction, presence of congestive heart failure, amiodarone therapy, and the outcome on electrophysiologic therapy. Thus, patients with a history of out-of-hospital sudden death, discharged following electrophysiologic guided therapy, require repeated antiarrhythmic dose titration for side effects or residual ventricular arrhythmia. Prompt diagnosis and treatment of potentially fatal arrhythmia is crucial and feasible, especially with regular ECG checks through telephone transmission.

A total of 99 consecutive 24-hour Holter recordings with ventricular tachycardia were reviewed. Ventricular premature beats which occurred alone, and ventricular premature beats which initiated ventricular tachycardia were examined to determine which characteristics correlated with occurrence of ventricular tachycardia and which predicted rate and duration of ventricular tachycardia. The preceding R-R interval, the coupling interval, and a ratio of the two were examined. We found that ventricular tachycardia rate and duration increase with a shorter coupling interval, and the coupling interval/preceding R-R ratio was significantly different in single beats not initiating ventricular tachycardia. The ratio for the beat initiating ventricular tachycardia was smaller, indicating more prematurity.

His bundle electrocardiography was performed on a patient with accidental hypothermia on whom the standard electrocardiogram (ECG) showed absent P waves, prominent J waves and a slightly irregular rhythm. Sino-ventricular conduction and a prolonged AH interval not responsive to atropine were found. These abnormalities reversed with rewarming.