Prognosis of patients with ventricular tachycardia or fibrillation and a normal electrophysiologic study The outcome of 26 patients with sustained ventricular tachycardia (n = 16) or ventricular fibrillation (n = 10) and no inducible ventricular tachycardia (110 beats) by baseline programmed stimulation was studied. Coronary artery disease was present in 14 patients, dilated cardiomyopathy was seen in seven, valvular heart disease was present in two, and no apparent cardiac abnormalities were found in three. The mean left ventricular ejection fraction was 53 + 14%. During the follow-up period of 24 + 16 months, actuarial survival rates at 1 and 2 years were 95% and 89% for sudden death and 95% and 83% for total cardiac death, respectively. No patients with a known ejection fraction >30% dted suddenly during the follow-up. Noninducibility by programmed stimulation in patients with sustained ventricular tachycardia or fibrillation is associated with a relatively preserved ventricular function. It may predict a low risk of sudden death in patients with preserved ventricular function. (AM HEART J 1991;121:77.)

Soo G. Kim, MD, Alan P. Aboaf, MD, James Roth, MD, Kevin Ferrick, MD, and John D. Fisher, MD. Bronx, IV. Y.

Programmed stimulation (PES) has been used widely in the management of ventricular tachycardia or ventricular fibrillation.lw4 When a regimen effective by PES criteria can be found, the patient will have a favorable outcome. However, in some patients ventricular tachycardia cannot be induced by PES at baseline in spite of spontaneous occurrence of ventricular tachyacardia or fibrillation. Antiarrhythmic therapy of these patients, therefore, cannot be guided by PES. The clinical outcome of these patients is controversial. Some investigators4-l1 have reported a good outcome, while others121 l3 have reported a poor outcome. In this study, we examined the outcome of these patients with malignant ventricular arrhythmias without inducible ventricular tachycardia at baseline. METHODS Patients.

The study population included patients with sustained ventricular tachycardia or ventricular fibrillation referred to the Arrhythmia Service of Montefiore

From the Department of Medicine, Division of Cardiology, Service, Montefiore Medical Center/Moses Division, Albert lege of Medicine. Received

for publication

May

Reprint Medical

requests: Soo C. Kim, Center, 111 East 210th

4/l/251

16

25, 1990; accepted

July

Arrhythmia Einstein Col-

13, 1990.

MD, Division of Cardiology, St., Bronx, NY 10467.

Montefiore

Hospital Medical Center. Patients whose arrhythmia was associated with an acute myocardial infarction, electrolyte imbalances, drug therapy, myocarditis, or a long QT syndrome were excluded from the study. In all patients, ventricular tachycardia was noninducible (I 10 beats) by programmed stimulation at baseline in the absence of antiarrhythmic therapy. The average age of study patients was 57 f 11 years. There were 16 men and 10 women. The clinical arrhythmia was sustained ventricular tachycardia in 16 patients and ventricular fibrillation in 10 patients. Fourteen patients had coronary artery disease, seven patients had dilated cardiomyopathy, two patients had valvular heart disease, and three patients had no apparent heart disease. The average left ventricular ejection fraction (LVEF) was 52.9 + 14.2%; it ranged between 18% and 69 % . LVEF was