LIFE-THREATENING VENTRICULAR ARRHYTHMIAS IN PATIENTS WITH MINIMAL OR NO STRUCTURAL HEART-DISEASE - EXPERIENCE WITH THE IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR

Limited data exist about prognosis and appropriate treatment of life t hreatening ventricular arrhythmias in patients with no or minimal hear t disease. In this study we report on a series of patients who suffere d sudden cardiac death of syncope due to documented ventricular tachyc ardia (VT) or fibrillation (VF) and in whom no significant organic or metabolic heart disease was found after detailed diagnostic studies. A ll patients undergone an electrophysiologic study (EPS) and subsequent ly were treated with an automatic implantable cardioverter defibrillat or (ICD). They were followed up for arrhythmia recurrence and ICD shoc k. Nine patients were included (5 female) with a mean age of 35,3+ 8.5 years. Mean left ventricular ejection fraction was 74%. On EPS four p atients (45%) had inducible sustained monomorphic VT (SMVT) and two de veloped polymorphic VT degenerated into VF. Eight ICD shocks were enco untered during follow up (27.3+8.7 months). Seven of them considered a ppropriate and distributed in three patients. Shock free survival was 75% after one year and 63% after two years. Inducibility of SMVT corre lated with the greater chance of receiving an appropriate shock (p=0.0 47). These findings suggest a high recurrence rate of symptomatic and sustained idiopathic ventricular arrhythmias and prove that ICD treatm ent is effective and safe. Patients in whom SMVT is inducible have mos t benefit from it.