ANALYSIS OF THE TREATMENT OF SPONTANEOUS SUSTAINED STABLE VENTRICULAR-TACHYCARDIA

Objectives: To determine the termination rate of spontaneous sustained stable ventricular tachycardia (SSSVT) as a function of the first and second therapeutic interventions used, and to determine factors assoc iated with successful termination. Methods: A multihospital, retrospec tive analysis of the treatment of patients with SSSVT was performed, T he setting included 2 urban county hospitals, 2 urban private hospital s, and a Veterans Affairs hospital, Cases were identified by discharge diagnosis and ECG characteristics, and confirmed by electrophysiology study or ECG criteria, Results: There were 40 cases of SSSVT identifi ed, Excluding adenosine, 35 patients were treated with lidocaine as a first intervention. The rate of termination with lidocaine bolus was 1 7% (6 of 35) (95% CT 7-34%), Regarding the 35 patients initially treat ed with lidocaine, the odds of termination of SSSVT were 11 times grea ter in those without a history of previous myocardial infarction (MI) than in those with a history of MI (95% CI 0.96-551), Of the 29 patien ts who failed initial lidocaine treatment, 23 were treated with a seco nd lidocaine bolus, with a termination rate of 18% (4 of 22) (95% CI 5 -40%), Only 2 patients with sustained ventricular tachycardia had a co ncurrent MI, and the tachycardia was unresponsive to initial lidocaine bolus in both cases. Fifteen patients received adenosine with no tach ycardia terminations and no significant adverse effects, Conclusions: The rate of SSSVT termination with lidocaine was low, particularly in patients with a history of MI.