Author + information
- Received November 20, 1984
- Revision received February 20, 1985
- Accepted April 1, 1985
- Published online August 1, 1985.
- Mark H. Schoenfeld, MDa,
- Brian McGovern, MB,
- Hasan Garan, MDb,
- Elizabeth Kelly, RN,
- Gail Grant, BA and
- Jeremy N. Ruskin, MD, FACCb
- ↵aAddress for reprints: Mark H. Schoenfeld, MD, Cardiac Unit, Massachusetts General Hospital, Boston, Massachusetts 02114.
To determine those factors predictive of the ability to both initiate and suppress ventricular tachyarrhythmias during electrophysiologic study, the results of programmed cardiac stimulation were evaluated in 261 patients: 66 presenting with nonsustained ventricular tachycardia, 91 with sustained ventricular tachycardia and 104 with ventricular fibrillation. Multivariate logistic regression analysis revealed that the presenting arrhythmia was a potent and independent predictor of the ability to provoke ventricular arrhythmias at electrophysiologic study; a history of myocardial infarction and male sex were also significant independent predictors. Of patients presenting with sustained ventricular tachycardia, 89% (81 of 91) had inducible ventricular arrhythmias compared with 61 (40 of 66) and 66% (69 of 104) of patients with nonsustained ventricular tachycardia and ventricular fibrillation, respectively.
Complete suppression of inducible arrhythmias could be achieved in only 52% (34 of 66) of patients with sustained ventricular tachycardia, compared with 73 (24 of 33) and 75% (46 of 61) of patients presenting with nonsustained ventricular tachycardia and ventricular fibrillation, respectively. Multivariate analysis showed that the major independent determinants of the ability to suppress inducible arrhythmias were the number of drug trials performed before electrophysiologic study (inversely correlated) and the nature of the induced arrhythmia.
The nature of the presenting clinical arrhythmia is, therefore, a highly significant and independent predictor of the ability to induce ventricular arrhythmias during electrophysiologic testing and an important determinant of the ability to suppress induced arrhythmias in patients with spontaneous ventricular tachyarrhythmias.
↵b Drs. Garan and Ruskin are recipients of an Established Investigatorship (El 84-209 and El 81-177, respectively) from the American Heart Association, Dallas, Texas.
This work was supported in part by Grant 5R01-HL25992 from the National Institutes of Health, Bethesda, Maryland.
- Received November 20, 1984.
- Revision received February 20, 1985.
- Accepted April 1, 1985.
- American College of Cardiology Foundation