Author + information
- Received August 30, 1985
- Revision received November 13, 1985
- Accepted November 19, 1985
- Published online April 1, 1986.
- Neil M. Sokoloff, MDa,
- Scott R. Spielman, MD, FACC,
- Allan M. Greenspan, MD, FACC,
- Alan P. Rae, MD,
- Patricia M. Brady, RN,
- Harold R. Kay, MD and
- Leonard N. Horowitz, MD, FACC
- ↵aAddress for reprints: Neil M. Sokoloff, MD, Clinical Cardiac Electrophysiology Laboratory, Likoff Cardiovascular Institute, Hahnemann University and Hospital, Room 6617 NCB, Broad and Vine Streets, Philadelphia, Pennsylvania 19102.
The prognostic implications of changes in ventricular ectopic activity on serial 24 hour ambulatory electrocardiographic (Holter) recordings were prospectively evaluated in 107 patients with a history of sustained ventricular tachyarrhythmias treated with amiodarone for at least 30 days. Twenty-seven patients (25%) had insufficient ventricular ectopic activity < 10 ventricular premature complexes/h and no repetitive forms) on baseline Holter recordings for serial statistical analysis. In 53 (66%) of the remaining 80 patients, serial 24 hour Holter monitor recordings showed efficacy of treatment, defined as a 75% decrease in ventricular premature complexes, a 95% decrease in ventricular couplets and absence of ventricular tachycardia. During a mean followup period of 14.2 ± 9.9 months, 34 (32%) of the 107 patients had recurrence of a sustained ventricular tachyarrhythmia. Holter recording correctly predicted nine recurrences and correctly identified 37 patients who did not experience a recurrence. Holter efficacy failed to predict recurrence of a sustained ventricular tachyarrhythmia in 16 patients, and 18 patients remained free of recurrence despite failure to achieve Holter efficacy. The positive predictive value of Holter monitoring efficacy was 33% and the negative predictive value was 70%; however, these differences were not statistically significant by chi-square analysis. Similar results were obtained using Holter recordings performed relatively early in therapy (6 weeks and 4 months).
Of the 27 patients without significant ventricular ectopic activity on the baseline Holter recording, 9 had an arrhythmia recurrence despite continued infrequent ventricular premature complexes and no repetitive forms on subsequent recordings. The recurrence rate in this group (33%) was similar to the overall recurrence rate.
Therefore, among patients taking amiodarone for sustained ventricular tachyarrhythmias: 1) 25% will have insufficient ventricular ectopic activity on 24 hour Holter recordings for serial statistical analysis; and 2) in the remaining 75%, data obtained from serial Holter recordings are not predictive of arrhythmia recurrence.
- Received August 30, 1985.
- Revision received November 13, 1985.
- Accepted November 19, 1985.
- American College of Cardiology Foundation