Amiodarone therapy for sustained ventricular tachycardia after myocardial infarction: long-term follow-up, risk assessment and predictive value of programmed ventricular stimulation

We determine the value of the programmed ventricular stimulation (PVS) and of clinical, angiographic and electrophysiologic variables in assessing the long-term risk of arrhythmia recurrence in a group of coronary artery dise ased patients presenting with a first episode of monomorphic sustained vent ricular tachycardia (VT) treated with amiodarone. Mortality and arrhythmia recurrence rates were retrospectively assessed in 55 consecutive patients w ith previous myocardial infarction presenting with a first VT episode. Resu lts of left heart catheterization, echocardiography and time-domain signal- averaging were collected. Patients underwent PVS after amiodarone oral load ing and were classified according to inducibility before being all discharg ed on amiodarone (200 mg daily). The mean follow-up was 42+/-'31 months. To tal and cardiac mortality rates were 29% (16 patients) and 23% (13 patients ) respectively. Sudden death (SD) occurred in nine patients (16%). VT recur red in 13 patients (23%). Sustained monomorphic VT was inducible in 40 pati ents (72%) after amiodarone loading. Neither total mortality (10/40 vs. 6/1 5) nor cardiac mortality (3/40 vs. 1/15) were significantly different betwe en inducible and non-inducible patients. Recurrent VT rate was 27% (11/40 p atients) for the inducible group and 13% (2/15 patients) for the non-induci ble group (NS). SD occurred in 6/40 inducible patients (15%) and in 2/15 no n-inducible patients (13%) (NS). Arrhythmic events occurred in 42% (17/40) inducible patients vs. 26% (4/15) non-inducible patients (P=0.07). Paramete rs correlated with outcome were ejection fraction (EF) (5 SD/11 patients wi th EF <0.3 vs. 4/44 with EF >0.3, P=0.003), mitral insufficiency (MI) (4 SD /10 patients with MI vs. 4/44 patients without MI, P=0.004) and age (65+/-9 years for patients with VT recurrence vs. 58+/-9, P=0.02). Although the ri sk stratification can be improved, reliable and safe long-term prediction o f recurrence of malignant ventricular arrhythmia in individual patients can not be made. Consequently, the systematic implantation of a cardioverter-de fibrillator in case of a first episode of sustained VT occurring in coronar y artery disease patients should be further debated. (C) 2000 Elsevier Scie nce Ireland Ltd. All rights reserved.