USEFULNESS OF HOLTER MONITORING IN PREDICTING EFFICACY OF AMIODARONE THERAPY FOR SUSTAINED VENTRICULAR-TACHYCARDIA ASSOCIATED WITH CORONARY-ARTERY DISEASE

The ability of Hotter monitoring to predict clinical events during ami odarone therapy was evaluated in 83 patients with coronary artery dise ase and inducible monomorphic ventricular tachycardia. Sixty-four pati ents (77%) had significant ventricular ectopy activity (greater-than-o r-equal-to 10 ventricular premature complexes [VPCs]/hour) at baseline , and 19 (23%) did not; patients were similar in age (63 and 65 years, respectively; p = 0.24) and ejection fraction (31 and 32%, respective ly; p = 0.75). Over a mean of 23 +/- 17 months, there was no differenc e in arrhythmia recurrence (33 and 26%; p = 0.89) or sudden death (16 and 20%; p = 0.94) in patients with and without significant ectopy, re spectively. In patients with significant ectopy, amiodarone decreased VPC frequency from baseline to 2 weeks, but not from 2 to 6 weeks. For ty-two patients had >85% reduction in ectopy at 2 weeks; 20 patients d id not. However, this reduction of simple VPCs did not predict a decre ase in arrhythmic recurrence (29 vs 40%; p = 0.59) nor sudden death (2 5 vs 11%; p = 0.56) in patients with and without VPC suppression, resp ectively. Forty-five patients had Holter monitoring at 6 weeks. Twenty -one patients (47%) had >95% suppression of ectopy, and 24 did not. Ne ither the recurrence (38 vs 38%; p = 0.54) nor sudden death (33 vs 13% ; p = 0.45) rate was predicted by the degree of VPC suppression. Amiod arone is a powerful suppressant of VPCs, but Holter suppression of thi s ectopic activity is not predictive of clinical outcome.