PROGNOSTIC FACTORS AFTER SUSTAINED VENTRI CULAR-FIBRILLATION OR TACHYCARDIA - A MULTIVARIATE-ANALYSIS OF 160 CASES

The authors analysed survival of 160 patients (121 men and 31 women; a verage age 57.2 +/- 12.5 years; follow-up 29 +/- 20 months) treated fo r malignant ventricular arrhythmias (sustained ventricular tachycardia , ventricular fibrillation, syncope with inducible ventricular tachyca rdia). The therapeutic evaluation was frequently invasive (145 patient s underwent at least programmed ventricular stimulation, 108 patients underwent full endocavitary electrophysiological studies) and non-phar macological therapy was widely used (defibrillator n=44; antiarrhythmi c surgery n=28; ablative procedures n=19; transplantation n=7). The fo llowing underlying pathologies were observed : ischaemic heart disease n=120; non-ischaemic left heart disease n=19; right heart cardiac dis ease n=4; and apparently normal hearts n=17). The average ejection fra ction was 40.5+/-15.5% and 29 patients were in the NYHA functional cla sses III or IV. Fifty-five patients had life-threatening arrhythmias w hilst receiving amiodarone. At 2 years, the actuarial sudden death rat e was 5.9+/-2.1% and the actuarial total cardiac mortality rate was 13 .1+/-2.9%. Univariate analysis showed age, the presence of underlying cardiac disease, the presence of dilated cardiomyopathy, the absence o f an invasive approach, the need for basal pacing in electrical cardio version, the absence of betablocker therapy, a decreased left ventricu lar ejection fraction and a high NYHA functional class, to be predicti ve of sudden death. In multivariate analysis, age, the NYHA class for total cardiac mortality and the NYHA class for sudden death, were the only independant predictive factors. The authors conclude that in the era of invasive methods of evaluation and widespread use of non-pharma cological therapeutic methods, the symptomatology of cardiac failure a ssessed by the NYHA classification remains the most powerful independa nt prognostic factor after an episode of malignant ventricular arrhyth mia.