Diagnostic value of ventricular stimulation in patients with idiopathic dilated cardiomyopathy

To assess the response to programmed ventricular stimulation and the clinical outcome, we performed a prospective study in 103 patients with idiopathic dilated cardiomyopathy. The protocol used up to three extrastimuli delivered at two right ventricular sites during sinus rhythm and ventricular pacing at 100 and 150 beats/min and was repeated during infusion of 1 to 4 micrograms/min of isoproterenol. Sustained monomorphic ventricular tachycardia (VT) was induced in 8 of 11 patients with spontaneous sustained VT, in none of 35 patients without significant ventricular arrhythmias during Holter monitoring, and in 9 of 56 patients with salvos of ventricular premature beats. Isoproterenol infusion facilitated the induction of two episodes of sustained VT in patients with spontaneous sustained VT; however, in all but one of the remaining patients, induction of ventricular tachyarrhythmias was not impaired. During the follow-up period there were eight sudden deaths among patients who initially had syncope, inducible sustained VT, or both and three episodes of sustained VT in patients who initially had nonsustained VT but inducible sustained VT. Isoproterenol infusion can be used to safely facilitate induction of ventricular tachyarrhythmias in patients with dilated cardiomyopathy. The induction of sustained VT was associated with a poor prognosis.