PREDICTORS OF MORTALITY IN PATIENTS WITH SUSTAINED VENTRICULAR TACHYCARDIAS OR VENTRICULAR-FIBRILLATION AND DEPRESSED LEFT-VENTRICULAR FUNCTION - IMPORTANCE OF BETA-BLOCKADE

To study prognostic factors in patients with sustained ventricular tac hycardias (VT) or ventricular fibrillation (VF) complicated by left ve ntricular dysfunction, we evaluated the predictive value of demographi c, clinical, and hemodynamic parameters for cardiac mortality and sudd en cardiac death in 85 patients with VT or VF and left ventricular eje ction fraction <0.45 (mean 0.27 +/- 0.10). Patients underwent serial d rug testing and received appropriate antiarrhythmic treatment, with am iodarone given as last-resort therapy. During a follow-up of 24 +/- 13 months, 23 patients died of cardiac causes, and 18 of them died sudde nly. Left ventricular ejection fraction less than or equal to 0.27 and amiodarone treatment were related to greater cardiac mortality and in creased risk of sudden cardiac death, whereas beta-blockade was associ ated with improved survival. In the multivariate model cardiac mortali ty was best predicted by a left ventricular ejection fraction less tha n or equal to 0.27, and absence of beta-blockade and severe left ventr icular dysfunction were the strongest predictors of sudden cardiac dea th. We conclude that severe left ventricular dysfunction predicts incr eased cardiac mortality and high risk of sudden cardiac death. Moreove r, beta-blocking treatment is associated with lower cardiac mortality and a reduced risk of sudden cardiac death in patients with sustained VT or VF and depressed left ventricular function. beta-Blocking agents may therefore be an important addition to conventional antiarrhythmic treatment in patients with VT or VF and left ventricular dysfunction.