LONG-TERM PROGNOSIS OF SUSTAINED VENTRICU LAR-TACHYCARDIA

The authors anlysed the clinical and paraclinical variables of 116 pat ients admitted the Hopital Cardiologique de Lyon between 1986 and 1990 with sustained ventricular tachycardia without cardocirculatory arres t in order to determine the long-term outcome and the prognostic facto rs of death and recurrence. The average age of the patients was 56 +/- 15 years (mean =/- SD) and 83% were men. The mean ejection fraction w as 39 =/- 15%. Sixty-five had previous myocardial infarction (groupI); 30 (group II) had dilated cardiomyopathy (n=21), right ventricular dy splasia (n=4), hypertrophic cardiomyopathy (n=2), congenital (n=2) or valvular (n=1) heart disease. Group III comprised 21 patients with no apparent cardiac disease or isolated mitral valve prolapse. Brief sync ope was reported in 12 cases. The paraclinical investigations showed 4 6 patients (66%) with at least two criteria of positivity for ventricu lar late potentials; Holter recording showed doublets or runs of VES i n 46% of cases and sustained of non-sustained VT was induced during ex ercise testing in 16 patients (22%). Programmed ventricular stimulatio n triggered VT in 85%, 79% and 61% of patients in groups I, II and III respectively. The patients were treated with amiodarone in 65 cases, a betablocker in 25 cases, catheter ablation of the origin of the tach ycardia in 12 cases, antiarrhytmic surgery in 6 cases, coronary bypass grafting in 5 cases (with an associated anti-arrythmic procedure in 3 cases). An automatic defibrillator was implanted in 9 patients. The a verage follow-up period was 32 months (range: 17 days to 65 months). T hirty-two patients died of a cardiac cause including 18 sudden deaths (56%). The actuarial survival for the whole population was 88 +/- 3% a t 1 year and 60 +/- 6% at 5 years; this was significantly lower in gro up I than in group III: 37 +/- 8% versus 92 +/- 7%. Of the factors ana lysed, low ejection fraction, NYHA stage 2 or more dyspnoea, old age a nd the presence of atrial fibrillation were prognostic factors for the risk of death. The presence of ventricular late potentials and the in ducibility of VT by programmed ventricular stimulation were indicative of a high risk of recurrence of arrhythmic events: VT, defribrillator shock and sudden death. These results of patients admitted for VT sho w a globally poor outcome, related to left ventricular dysfunction. Th e inducibility of VT by ventricular stimulation and the presence of ve ntricular late potentials identify a group of patients with a high ris k of recurrence of a ventricular arrhythmic event.