Prospective evaluation of a discriminant function for prediction of recurrent symptomatic ventricular tachycardia or ventricular fibrillation in coronary artery disease patients receiving amiodarone and having inducible ventricular tachycardia at electrophysiologic study

Lawrence S. Klein, Naomi Fineberg, James J. Heger, William M. Miles, James M. Kammerling, Mau Song Chang, Douglas P. Zipes, Eric N. Prystowsky

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Induction of ventricular tachycardia (VT) at electrophysiologic study in patients taking amiodarone poorly predicts recurrence of VT. Consequently, a discriminant function was developed (Using parameters based on retrospective data) that appeared to identify high-risk patients. These parameters included ventricular effective refractory period, corrected QT interval, initiation of a repetitive ventricular response and the mode of VT induction. In the present study these parameters were prospectively evaluated in 60 patients with coronary artery disease and sustained VT or ventricular fibrillation (VF), in whom VT was still induced at electrophysiologic study during amiodarone therapy. Thirteen patients had recurrent events (sudden death in 8 and sustained VT in 5) and 47 patients had no symptomatic arrhythmia recurrence (followup for 16 ± 2 months, mean ± standard error of the mean). The ventricular effective refractory period, corrected QT interval and presence of a repetitive ventricular response did not discriminate between patients with and without symptomatic arrhythmia recurrence. However, an easier mode of VT induction during amiodarone therapy versus control was highly predictive of arrhythmia recurrence: 9 of 13 (69%) recurrences were in this group. In contrast, only 4 of 44 (9%) patients who had either the same or harder mode of VT induction had a recurrent event. Overall, 9 of 16 (56%) patients with an easier mode of VT induction had a recurrence, including 6 of the 8 patients with subsequent sudden cardiac death. It is concluded that electrophysiologic testing during amiodarone therapy is useful to identify high-risk patients.

Original languageEnglish
Pages (from-to)1024-1030
Number of pages7
JournalThe American Journal of Cardiology
Volume61
Issue number13
DOIs
StatePublished - May 1 1988

Fingerprint

Amiodarone
Ventricular Fibrillation
Ventricular Tachycardia
Coronary Artery Disease
Recurrence
Cardiac Arrhythmias
Sudden Cardiac Death
Sudden Death
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Prospective evaluation of a discriminant function for prediction of recurrent symptomatic ventricular tachycardia or ventricular fibrillation in coronary artery disease patients receiving amiodarone and having inducible ventricular tachycardia at electrophysiologic study. / Klein, Lawrence S.; Fineberg, Naomi; Heger, James J.; Miles, William M.; Kammerling, James M.; Chang, Mau Song; Zipes, Douglas P.; Prystowsky, Eric N.

In: The American Journal of Cardiology, Vol. 61, No. 13, 01.05.1988, p. 1024-1030.

Research output: Contribution to journalArticle

Klein, Lawrence S. ; Fineberg, Naomi ; Heger, James J. ; Miles, William M. ; Kammerling, James M. ; Chang, Mau Song ; Zipes, Douglas P. ; Prystowsky, Eric N. / Prospective evaluation of a discriminant function for prediction of recurrent symptomatic ventricular tachycardia or ventricular fibrillation in coronary artery disease patients receiving amiodarone and having inducible ventricular tachycardia at electrophysiologic study. In: The American Journal of Cardiology. 1988 ; Vol. 61, No. 13. pp. 1024-1030.
@article{d2eddef78fb14a63b68c8a24ab32766f,
title = "Prospective evaluation of a discriminant function for prediction of recurrent symptomatic ventricular tachycardia or ventricular fibrillation in coronary artery disease patients receiving amiodarone and having inducible ventricular tachycardia at electrophysiologic study",
abstract = "Induction of ventricular tachycardia (VT) at electrophysiologic study in patients taking amiodarone poorly predicts recurrence of VT. Consequently, a discriminant function was developed (Using parameters based on retrospective data) that appeared to identify high-risk patients. These parameters included ventricular effective refractory period, corrected QT interval, initiation of a repetitive ventricular response and the mode of VT induction. In the present study these parameters were prospectively evaluated in 60 patients with coronary artery disease and sustained VT or ventricular fibrillation (VF), in whom VT was still induced at electrophysiologic study during amiodarone therapy. Thirteen patients had recurrent events (sudden death in 8 and sustained VT in 5) and 47 patients had no symptomatic arrhythmia recurrence (followup for 16 ± 2 months, mean ± standard error of the mean). The ventricular effective refractory period, corrected QT interval and presence of a repetitive ventricular response did not discriminate between patients with and without symptomatic arrhythmia recurrence. However, an easier mode of VT induction during amiodarone therapy versus control was highly predictive of arrhythmia recurrence: 9 of 13 (69{\%}) recurrences were in this group. In contrast, only 4 of 44 (9{\%}) patients who had either the same or harder mode of VT induction had a recurrent event. Overall, 9 of 16 (56{\%}) patients with an easier mode of VT induction had a recurrence, including 6 of the 8 patients with subsequent sudden cardiac death. It is concluded that electrophysiologic testing during amiodarone therapy is useful to identify high-risk patients.",
author = "Klein, {Lawrence S.} and Naomi Fineberg and Heger, {James J.} and Miles, {William M.} and Kammerling, {James M.} and Chang, {Mau Song} and Zipes, {Douglas P.} and Prystowsky, {Eric N.}",
year = "1988",
month = "5",
day = "1",
doi = "10.1016/0002-9149(88)90119-1",
language = "English",
volume = "61",
pages = "1024--1030",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "13",

}

TY - JOUR

T1 - Prospective evaluation of a discriminant function for prediction of recurrent symptomatic ventricular tachycardia or ventricular fibrillation in coronary artery disease patients receiving amiodarone and having inducible ventricular tachycardia at electrophysiologic study

AU - Klein, Lawrence S.

AU - Fineberg, Naomi

AU - Heger, James J.

AU - Miles, William M.

AU - Kammerling, James M.

AU - Chang, Mau Song

AU - Zipes, Douglas P.

AU - Prystowsky, Eric N.

PY - 1988/5/1

Y1 - 1988/5/1

N2 - Induction of ventricular tachycardia (VT) at electrophysiologic study in patients taking amiodarone poorly predicts recurrence of VT. Consequently, a discriminant function was developed (Using parameters based on retrospective data) that appeared to identify high-risk patients. These parameters included ventricular effective refractory period, corrected QT interval, initiation of a repetitive ventricular response and the mode of VT induction. In the present study these parameters were prospectively evaluated in 60 patients with coronary artery disease and sustained VT or ventricular fibrillation (VF), in whom VT was still induced at electrophysiologic study during amiodarone therapy. Thirteen patients had recurrent events (sudden death in 8 and sustained VT in 5) and 47 patients had no symptomatic arrhythmia recurrence (followup for 16 ± 2 months, mean ± standard error of the mean). The ventricular effective refractory period, corrected QT interval and presence of a repetitive ventricular response did not discriminate between patients with and without symptomatic arrhythmia recurrence. However, an easier mode of VT induction during amiodarone therapy versus control was highly predictive of arrhythmia recurrence: 9 of 13 (69%) recurrences were in this group. In contrast, only 4 of 44 (9%) patients who had either the same or harder mode of VT induction had a recurrent event. Overall, 9 of 16 (56%) patients with an easier mode of VT induction had a recurrence, including 6 of the 8 patients with subsequent sudden cardiac death. It is concluded that electrophysiologic testing during amiodarone therapy is useful to identify high-risk patients.

AB - Induction of ventricular tachycardia (VT) at electrophysiologic study in patients taking amiodarone poorly predicts recurrence of VT. Consequently, a discriminant function was developed (Using parameters based on retrospective data) that appeared to identify high-risk patients. These parameters included ventricular effective refractory period, corrected QT interval, initiation of a repetitive ventricular response and the mode of VT induction. In the present study these parameters were prospectively evaluated in 60 patients with coronary artery disease and sustained VT or ventricular fibrillation (VF), in whom VT was still induced at electrophysiologic study during amiodarone therapy. Thirteen patients had recurrent events (sudden death in 8 and sustained VT in 5) and 47 patients had no symptomatic arrhythmia recurrence (followup for 16 ± 2 months, mean ± standard error of the mean). The ventricular effective refractory period, corrected QT interval and presence of a repetitive ventricular response did not discriminate between patients with and without symptomatic arrhythmia recurrence. However, an easier mode of VT induction during amiodarone therapy versus control was highly predictive of arrhythmia recurrence: 9 of 13 (69%) recurrences were in this group. In contrast, only 4 of 44 (9%) patients who had either the same or harder mode of VT induction had a recurrent event. Overall, 9 of 16 (56%) patients with an easier mode of VT induction had a recurrence, including 6 of the 8 patients with subsequent sudden cardiac death. It is concluded that electrophysiologic testing during amiodarone therapy is useful to identify high-risk patients.

UR - http://www.scopus.com/inward/record.url?scp=0023929256&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0023929256&partnerID=8YFLogxK

U2 - 10.1016/0002-9149(88)90119-1

DO - 10.1016/0002-9149(88)90119-1

M3 - Article

VL - 61

SP - 1024

EP - 1030

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 13

ER -