OUTCOME OF PATIENTS WITH NONSUSTAINED VENTRICULAR-TACHYCARDIA AND SEVERELY IMPAIRED VENTRICULAR-FUNCTION WHO HAVE NEGATIVE ELECTROPHYSIOLOGIC STUDIES

Twenty-nine consecutive patients with a prior myocardial infarction, s everely reduced left ventricular ejection fraction (26% +/- 8%), and a symptomatic nonsustained ventricular tachycardia were enrolled in a pr ospective trial. After a negative programmed electric stimulation stud y (3 extrastimuli at 2 sites with 2 drive trains), the 26 men and 3 wo men (mean age 71) were monitored for a mean of 13 months without antia rrhythmic drug therapy. Five patients died suddenly or had sustained v entricular tachycardia; three others had a cardiac, nonarrhythmic deat h, Events occurred in the first 13 months of the surveillance period, Clinical factors associated with a poor outcome included congestive he art failure and lack of beta-blocker therapy. In addition, patients wi th events tended to have lower ejection fractions than those without ( 21% vs 28%, p not significant), Thus a negative programmed electric st imulation study does not necessarily imply a benign outcome in patient s with a prior infarction and nonsustained ventricular tachycardia if they also have severe left ventricular dysfunction and a history of he art failure, These data have important implications for the design and conduct of contemporary clinical trials.