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Long-term follow-up in patients with incessant ventricular tachycardia
R J Hariman1, D Y Hu, J L Gallastegui
1Department of Medicine, University of Illinois College of Medicine, Chicago.
Insights
Incessant ventricular tachycardia (VT) can resolve in over half of patients after stopping antiarrhythmic drugs. This study suggests trials of drug discontinuation may be beneficial for patients with this condition.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Incessant ventricular tachycardia (VT) poses a significant risk, often managed with antiarrhythmic drugs.
- Patient selection criteria included coronary artery disease, idiopathic dilated cardiomyopathy, or no organic heart disease.
Purpose of the Study:
- To investigate the remission rates of incessant ventricular tachycardia (VT) after discontinuation of antiarrhythmic drugs.
- To assess the long-term outcomes and potential for spontaneous remission in patients with incessant VT.
Main Methods:
- Seventeen patients with incessant VT were followed for a mean of 51 months.
- Exclusion criteria included electrolyte disorders, prolonged QT interval, drug-induced arrhythmias, or recent myocardial infarction.
- Remission was assessed after antiarrhythmic drug discontinuation, either due to adverse effects or deliberate attempts.
Main Results:
- Nine out of 17 patients (53%) achieved remission of incessant VT after discontinuing antiarrhythmic drugs.
- Remission occurred over a mean follow-up of 55 months after drug cessation.
- Four of 5 patients in whom drug discontinuation was deliberately attempted experienced remission.
Conclusions:
- A significant proportion of patients with incessant VT experience remission after discontinuing antiarrhythmic drugs.
- The findings support trials of antiarrhythmic drug discontinuation in patients surviving incessant VT.
- Further research is warranted to confirm the efficacy of this approach.
Abstract:
Seventeen patients with coronary artery disease, idiopathic dilated cardiomyopathy or no organic heart disease who presented with incessant ventricular tachycardia (VT) were studied and followed for a mean period of 51 +/- 35 months. In these patients the incessant VT included greater than or equal to 3 episodes of sustained VT at a rate of greater than or equal to 120 beats/min and frequent episodes of nonsustained VT over a 24-hour period. No patient had electrolyte disorder, prolonged QT interval, drug-induced arrhythmia or myocardial infarction less than 2 weeks old. Six patients died within 27 months of follow-up; 4 from sudden death and 2 from acute myocardial infarction. Three of the 11 surviving patients had remission of their VT within 1 week after the diagnosis of incessant VT. In 3 other patients in whom antiarrhythmic drugs were discontinued during follow-up because of adverse effects of the drugs or other medical reasons, 2 were found in remission. In the remaining 5 alive patients, deliberate attempts were made to discontinue the antiarrhythmic drugs; 4 of these patients were found in remission when the drugs were discontinued. Thus, 9 of these patients (53%) with incessant VT had remission over a mean follow-up of 55 +/- 34 months after discontinuation of the antiarrhythmic drugs. The probability of remission in patients surviving incessant VT warrants trials of discontinuation of antiarrhythmic drugs in these patients.