Long-term outcome in patients who survive out of hospital ventricular fibrillation and undergo electrophysiologic studies: evaluation by electrophysiologic subgroups

Department of Medicine (Cardiology), University of Washington, Seattle.

The long-term outcome of 241 survivors of out of hospital ventricular fibrillation who underwent programmed electrical stimulation was evaluated. Patients were categorized according to the rhythm induced at baseline drug-free electrophysiologic testing. Ventricular fibrillation was induced in 39 patients (16%) (Group 1), sustained ventricular tachycardia in 66 patients (27%) (Group 2) and nonsustained ventricular tachycardia in 34 patients (14%) (Group 3); 102 patients (42%) (Group 4) did not have an arrhythmia inducible at baseline electrophysiologic testing. Antiarrhythmic drugs were administered over the long term to 92% of patients in Group 2, 91% of patients in Group 1 and 47% of patients in Group 4. At a mean follow-up time of 30 +/- 15 months, recurrent sudden cardiac death or nonfatal ventricular fibrillation occurred in 11 (28%) of 39 patients with inducible ventricular fibrillation (Group 1), 14 (21%) of 66 patients with inducible sustained ventricular tachycardia (Group 2), 4 (12%) of 34 patients with inducible nonsustained ventricular tachycardia (Group 3) and 16 (16%) of 102 patients without inducible arrhythmias (Group 4). Actuarial analysis revealed a 2 year cumulative arrhythmia-free survival rate of 65% for patients in Group 2, 71% for patients in Group 1, 79% for patients in Group 3 and 81% for patients in Group 4 (p = 0.02). Actuarial survival of patients with inducible sustained ventricular tachycardia or ventricular fibrillation suppressed by electrophysiologically guided drug therapy was not significantly different from that in patients whose arrhythmia was not suppressed. Multivariate regression analysis revealed that only the presence of congestive heart failure was an independent predictor of outcome in these patients.(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				R. Cappato, S. Boczor, K.-H. Kuck, and on behalf of the CASH Investigators Response to programmed ventricular stimulation and clinical outcome in cardiac arrest survivors receiving randomised assignment to implantable cardioverter defibrillator or antiarrhythmic drug therapy Eur. Heart J., April 2, 2004; 25(8): 642 - 649. [Abstract] [Full Text] [PDF]

				S Takatsuki, H Mitamura, and S Ogawa Catheter ablation of a monofocal premature ventricular complex triggering idiopathic ventricular fibrillation Heart, July 1, 2001; 86(1): e3 - 3. [Abstract] [Full Text] [PDF]

				G. Gronefeld and S. H Hohnloser What do implantable cardioverter/defibrillators teach us about the mechanisms of sudden cardiac death? Cardiovasc Res, May 1, 2001; 50(2): 232 - 241. [Abstract] [Full Text] [PDF]

				D. Corrado, C. Basso, and G. Thiene Sudden cardiac death in young people with apparently normal heart Cardiovasc Res, May 1, 2001; 50(2): 399 - 408. [Abstract] [Full Text] [PDF]

				S. S. Chugh, K. L. Kelly, and J. L. Titus Sudden Cardiac Death With Apparently Normal Heart Circulation, August 8, 2000; 102(6): 649 - 654. [Abstract] [Full Text] [PDF]

				R. Ruppel, C. A. Schluter, S. Boczor, T. Meinertz, M. Schluter, K.-H. Kuck, and R. Cappato Ventricular tachycardia during follow-up in patients resuscitated from ventricular fibrillation: experience from stored electrograms of implantable cardioverter-defibrillators J. Am. Coll. Cardiol., November 15, 1998; 32(6): 1724 - 1730. [Abstract] [Full Text] [PDF]

				D. Mehta, J. Curwin, J. A. Gomes, and V. Fuster Sudden Death in Coronary Artery Disease : Acute Ischemia Versus Myocardial Substrate Circulation, November 4, 1997; 96(9): 3215 - 3223. [Full Text]

				Survivors of Out-of-Hospital Cardiac Arrest With Apparently Normal Heart: Need for Definition and Standardized Clinical Evaluation Circulation, January 7, 1997; 95(1): 265 - 272. [Abstract] [Full Text]

				J. Villacastin, J. Almendral, A. Arenal, J. Albertos, J. Ormaetxe, R. Peinado, H. Bueno, J. L. Merino, A. Pastor, O. Medina, et al. Incidence and Clinical Significance of Multiple Consecutive, Appropriate, High-Energy Discharges in Patients With Implanted Cardioverter-Defibrillators Circulation, February 15, 1996; 93(4): 753 - 762. [Abstract] [Full Text]

				E. F.D. Wever, R. N.W. Hauer, G. Schrijvers, F. J.L. van Capelle, J. G.P. Tijssen, H. J.G.M. Crijns, A. Algra, H. Ramanna, P. F.A. Bakker, and E. O. Robles de Medina Cost-effectiveness of Implantable Defibrillator as First-Choice Therapy Versus Electrophysiologically Guided, Tiered Strategy in Postinfarct Sudden Death Survivors : A Randomized Study Circulation, February 1, 1996; 93(3): 489 - 496. [Abstract] [Full Text]

				M. H. Raitt, G. L. Dolack, P. J. Kudenchuk, J. E. Poole, and G. H. Bardy Ventricular Arrhythmias Detected After Transvenous Defibrillator Implantation in Patients With a Clinical History of Only Ventricular Fibrillation : Implications for Use of Implantable Defibrillator Circulation, April 1, 1995; 91(7): 1996 - 2001. [Abstract] [Full Text]