Value of programmed ventricular stimulation in patients with congenital heart disease

Ventricular Stimulation in Congenital Heart Disease, Introduction: The role of programmed ventricular stimulation (VSTIM) for risk stratification in c ongenital heart disease is unclear. We analyzed the results of VSTIM in sel ected congenital heart disease survivors at a single center to determine wh ether it improved the ability to predict a serious outcome. Methods and Results: Between July 1985 and September 1996, 140 primary VSTI M studies were performed on 130 patients (median age 18.1 years, range 0 to 51). Tetralogy of Fallot (33%), d-transposition of the great arteries (25% ), and left ventricular outflow tract obstruction (12%) accounted for the m ajority of patients, Indications included spontaneous ventricular tachycard ia (VT) of greater than or equal to 3 beats (72%) and/or symptoms (68%), Su stained VT was induced in 25% of the studies, and nonsustained VT in 12%, A trial flutter or other supraventricular tachycardia was documented in 32% a nd bradyarrhythmias in 26%, By univariate analysis, mortality was increased in patients with positive VSTIM versus negative VSTIM (18% vs 7%, P = 0.04 ). Using multivariate analysis, positive VSTIM was associated with a sixfol d increased risk of decreased survival and a threefold increased risk of se rious arrhythmic events, allowing up to 87% sensitivity in predicting morta lity. However, 7 (33%) of 21 patients with documented clinical VT had false -negative studies. Conclusion: VSTIM in a large, selected group of congenital heart disease pa tients identified a subgroup with significantly increased mortality and sud den arrhythmic events. Failure to induce VT was a favorable prognostic sign , but the frequency of false-negative studies was high. Frequent supraventr icular tachycardia further complicated risk stratification. Although VSTIM appears to be a reasonable tool for evaluation of this population, a larger , multicenter trial is recommended to clarify its utility.