Electrophysiologic study in the management of cardiac arrest survivors: a critical review

This review discusses the value and limitations of EPS in the management of cardiac arrest survivors. Uncertainties associated with EPS include a lack of consensus with respect to stimulation protocol, end points for VT suppression during drug testing, significance of induced polymorphic VT or VF, and timing of EPS after myocardial infarction. Despite methodologic shortcomings in most clinical studies, a useful body of knowledge has emerged. In cardiac arrest survivors, incidence of inducible sustained VT ranged from 35% to 75%. Where induced VT (sustained or nonsustained) was successfully suppressed, recurrent arrhythmic events occurred in 0% to 33% of patients over a 1- to 5-year follow-up period. Failed regimens correlated with a high risk of arrhythmic recurrence. EPS also helps to select patients for the implantable defibrillator or electrocardiac surgery. In conclusion, EPS appears empirically useful in the management of cardiac arrest survivors with coronary artery disease; its value in other disease entities is uncertain.