Copyright © 1980 by the European Society of Cardiology.
© 1980 The European Society of Cardiology
Serial electrophysiological testing of antiarrhythmic drug efficacy in patients with recurrent ventricular tachycardia
Medizinische Klinik u. Poliklinik, Klinik B (Kardiologie), Universität Düsseldorf D 4000 Düsseldorf, Germany
Received 13 September 1979; .
The purpose of the present study was to determine the predictive value of serial electrophysiological testing during antiarrhythmic therapy in patients with recurrent ventricular tachycardia and/or ventricular fibrillation in regard to symptomatic status and outcome.
Eleven patients (ten male, one female, mean age 54 ± 10 years, mean ± S.D.J with recurrent ventricular tachycardia were studied. Mean ejection fraction was 34 ± 12%. Most patients suffered from coronary artery disease. The median duration of recurrent ventricular tachycardia before the study was 12 weeks (minimum one week, maximum 16 years). In seven patients between one and 61 cardioversions had been performed before the study to terminate ventricular tachycardia.
Ventricular tachycardia could be initiated by programmed right ventricular stimulation in all patients. After control recordings had been obtained, the stimulation tests were repeated during antiarrhythmic therapy until an effective regimen was found. The following drugs were used in this sequence: disopyramide, mexiletine, propafenone, aprindine plus beta-adrenergic blocking drugs and digitalis.
In three patients, there was no change in the inducibility of ventricular tachycardia during therapy whereas in eight patients, ventricular tachycardia was more difficult to induce or no longer inducible. Patients were followed at regular intervals (mean follow-up time 41 ± 22 weeks). In those three patients in whom ventricular tachycardia was still inducible, two sudden deaths occurred; one patient was referred to surgery because of persistent spontaneous and inducible attacks of ventricular tachycardia despite antiarrhythmic therapy. No cardiac death occurred in the eight patients in whom ventricular tachycardia was more difficult to induce or no longer inducible. All patients were asymptomatic, and had no recurrence of their ventricular tachycardia in their Hotter ECGs.
Thus far, serial electrophysiological testing has been useful in predicting antiarrhythmic drug efficacy in patients with recurrent ventricular tachycardia. It may help to prevent sudden death in these highly endangered patients.
Key Words: Ventricular stimulation • antiarrhythmic drugs