LATE OUTCOME OF SURVIVORS OF IDIOPATHIC VENTRICULAR-FIBRILLATION

This report describes clinical, hemodynamic, and electrophysiologic ch aracteristics of 18 consecutive survivors of sudden cardiac arrest due to idiopathic ventricular fibrillation (VF) between 1986 and 1996. Lo ng-term data in relation to the prescribed therapy are presented. The mean age of the 18 patients was 48 +/- 14 years (median 49). Electroph ysiologic studies showed a low inducibility of sustained ventricular t achyarrhythmias in 4 patients (22%). Treatment consisted of class III agents, beta blockers, or implantable cardioverter-defibrillators. Two patients were discharged without any therapy. Therapy control was und ertaken either by serial drug testing or by the empirical approach. Se rious complications of therapy occurred in 2 patients: 1 patient exper ienced a proarrhythmic effect of antiarrhythmic drug therapy, and the other patient received multiple inadequate defibrillator discharges du e to a defect in the transvenous lead, All but 1 patient (94%) remaine d free of recurrences of sudden cardiac arrest during a follow-vp time of 45 +/- 29 months (median 41), One patient died 2 weeks after survi ving cardiac arrest due to intractable VF while receiving sotalol trea tment. Therapy guided by electrophysiologic studies did not have any i mpact on survival. Adverse effects or noncompliance led to discontinua tion of drug therapy in 7 patients after a mean period of 31 +/- 30 mo nths. Without any treatment 9 patients remained without recurrences ov er 45 +/- 33 months. Because of rite absence of risk factors for arrhy thmia recurrence and criteria to select therapy, randomized prospectiv e studies are warranted to assess the optimal therapies in these young , ostensibly healthy patients. (C) 1998 by Excerpta Medica, Inc.