Sustained ventricular arrhythmias: Differences between survivors of cardiac arrest and patients with recurrent sustained ventricular tachycardia

Abstract

Clinical, angiographic, echocardiographic and electrophysiologic data were examined in 101 patients with a history of sustained ventricular arrhythmia not associated with acute myocardial infarction. These patients included 66 survivors of out of hospital cardiac arrest and 35 patients presenting with hemodynamically well tolerated sustained ventricular tachycardia. On univariate analysis, patients in the cardiac arrest group had a lower incidence of previous myocardial infarction and left ventricular aneurysm and a higher ejection fraction compared with the ventricular tachycardia group. During electrophysiologic testing, the arrhythmia induced in the patients in the cardiac arrest group was fast and polymorphic and frequently degenerated into ventricular fibrillation. In contrast, in the ventricular tachycardia group, a slower, monomorphic and hemodynamically well tolerated ventricular tachycardia was commonly induced. On multivariate analysis, a polymorphic pattern of the induced ventricular arrhythmia was the only independent variable that distinguished the survivors of cardiac arrest from those presenting with sustained ventricular tachycardia. These results suggest that 1) the survivors of cardiac arrest and patients presenting with sustained well tolerated ventricular tachycardia are clinically distinct groups; and 2) the polymorphic tachycardia induced during programmed electrical stimulation in the survivors of cardiac arrest may indicate an unstable tachycardia mechanism. This may explain why these patients present with ventricular fibrillation and cardiac arrest, whereas others present with hemodynamically stable ventricular tachycardia.

Comparison of sotalol with amiodarone for long-term treatment of spontaneous sustained ventricular tachyarrhythmia based on coronary artery disease

“…In our study, the survival free of ventricular tachyarrhythmia on amiodarone at 2 years was 50%. The difference in the outcome with amiodarone between the CASCADE study and our study can be explained by the differences in prognosis between patients who present with ventricular fibrillation versus ventricular tachycardia [23,24] . Patients with ventricular tachycardia have higher recurrence rates of ventricular tachyarrhythmia and poorer long-term prognosis than patients with ventricular fibrillation.…”

Clinical features of sustained ventricular tachycardia among various underlying heart diseases.

“…In western countries, sustained VT is most commonly associated with myocardial infarction (Adhar et al 1988;Trappe et al 1988). Therefore, previous studies compared the clinical and electrophysiological findings of VT between patients with and without myocardial infarction (Wellens et al 1982;Trappe et al 1988).…”

“…Sustained ventricular tachycardia (sustained VT) has many clinical manifestations : palpitations, heart failure, syncope (Harmer et al 1984; Morady et al 1985) and even sudden death (Adhar et al 1988; Trappe et al 1988). Several investigators have examined the clinical and electrophysiologic findings in patients with sustained VT (Morally et al 1985; Trappe et al 1988).…”

É Imperiosa a Indicação de Estudo Eletrofisiológico Invasivo em Pacientes Sobreviventes de Parada Cardíaca?

“…Em sobreviventes de parada cardíaca, mesmo quando sabidamente por fibrilação ventricular, em apenas 70% dos casos se consegue indução de algum tipo de taquicardia ventricular no estudo eletrofisiológico invasivo, sendo que a taquicardia ventricular monomórfica sustentada corresponde somente a algo em torno de 40% das taquicardias induzidas [21][22][23][24][25][26][27][28][29] . Ainda, a incapacidade de induzir taquicardia ventricular não é indicativa de bom prognóstico, visto que os índices de recorrência de morte súbita nesses casos podem chegar a até 17% em 21 meses 24 .…”