Location of death (in-hospital or out-of-hospital) and type of death (arrhythmic, nonarrhythmic, noncardiac) after inducible sustained ventricular tachyarrhythmias after syncope, sustained ventricular tachycardia, or nonfatal cardiac arrest (The ESVEM Trial)

The ESVEM Trial evaluated methods to guide antiarrhythmic drug use in patie nts with spontaneous, inducible sustained tachyarrhythmias at electrophysio logic testing and frequent ventricular premature complexes (VPCs) per hour (greater than or equal to 10). We assessed the relation between location (i n-hospital or out-of-hospital) and classification of death (arrhythmic, non arrhythmic, cardiac and/or noncardiac) for 486 randomized patients. Deaths were classified as out-of-hospital arrhythmic deaths if arrhythmic death oc curred out-of-hospital, or if an arrhythmia preceded hospital admission and directly caused death. Of the 486 randomized patients, 188 (39%) died duri ng 6 years of follow-up. The location and type of death could be determined clearly in 171 patients (91%). Ninety-one deaths were in-hospital (53%); 8 0 were out-of-hospital (47%). Arrhythmic deaths occurred in 85% out-of-hosp ital patients and in 30% in hospital patients (p <0.001). Baseline characte ristics were comparable for patients with out-of-hospital and in-hospital a rrhythmic deaths. Twenty-seven of 95 arrhythmic deaths occurred in-hospital (28%); 72% occurred out-of-hospital. Out-of-hospital arrhythmic death acco unted for 40% of deaths for which location and type of information were ava ilable. The 1- and 4-year actuarial out-of-hospital arrhythmic death rates were 9% and 18%, respectively. Of nonarrhythmic cardiac deaths, 91% were in -hospital and 9% were out-of-hospital. Of noncardiac deaths, 74% were in-ho spital and 26% were out-of-hospital. Similar results were seen in the 296 p atients for whom a drug was considered to be effective. Thus, over half the deaths in the ESVEM trial occurred in-hospital. The long-term actuarial ri sk of out-of-hospital arrhythmic death in ESVEM was unexpectedly low. (C) 2 000 by Excerpta Medica, Inc.