Screening and therapy for patients with nonsustained ventricular tachycardia

Patients with coronary artery disease, nonsustained ventricular tachycardia (VT), and left ventricular dysfunction have an increased risk for sudden c ardiac death, Two randomized prospective trials, the Multicenter Unsustaine d Tachycardia Trial (MUSTT) and the Multicenter Automatic Defibrillator imp lantation Trial (MADIT), employed electrophysiologic testing for risk strat ification in these types of patients. Individuals with inducible sustained VT were randomized to receive implantable cardioverter defibrillators (ICDs ) or "conventional" therapy in MADIT, or were given no specific antiarrhyth mic treatment vs electrophysiologically guided therapy in MUSTT. Both trial s showed that overall mortality was reduced by approximately 50% with ICD t herapy. in MUSTT, patients received no survival benefit with electrophysiol ogically guided drug treatment, MUSTT also demonstrated that untreated pati ents with inducible sustained VT had a worse prognosis than patients in who m sustained VT could not be initiated at electrophysiologic study. Even so, the data suggest that electrophysiologic testing alone may not be sensitiv e enough to identify broader groups of patients at risk for sudden death. I n conclusion, patients with nonsustained VT who have coronary artery diseas e and a left ventricular ejection fraction <0.40 should undergo electrophys iologic testing, and if sustained VT is induced, ICD therapy should be pres cribed, (C) 2000 by Excerpta Medica, Inc.