Ventricular fibrillation survivors in whom tachyarrhythmia cannot be induced: outcome related to selected therapy

Eight-five patients were studied to determine the prognosis of the ventricular tachyarrhythmias at the time of electrophysiologic study. Twenty-five patients (29%) were not inducible when we used a stimulation protocol consisting of up to four extrastimuli delivered at two right ventricular sites. Patients with no inducible arrhythmias were younger (53 vs 59 yrs; p = .06) and had higher ejection fractions (.49 vs .34; p less than .04) than the inducible ventricular fibrillation survivors. Sex, cardiac diagnosis, time from event to electrophysiologic study, and antiarrhythmic therapy at the time of event did not discriminate between those with and those without inducible ventricular tachyarrhythmias. Survival free of recurrent sudden death or ventricular tachycardia was .86 +/- .05 and .95 +/- .05 for patients with and without inducible tachyarrhythmias, respectively (p = .22). Nine of 25 (36%) patients with no inducible arrhythmias developed inducible ventricular tachyarrhythmias when testing was repeated with an antiarrhythmic drug. Ventricular fibrillation survivors not inducible at the time of programmed ventricular stimulation (using a stimulation protocol consisting of four extrastimuli delivered at two right ventricular sites) seem to have a good prognosis. Many "noninducible" patients develop inducible tachyarrhythmias when placed on antiarrhythmic therapy. Because it is possible that these drugs are proarrhythmic, empiric antiarrhythmic therapy should be avoided in these patients.