[Role of Holter electrocardiogram in the evaluation of anti-arrhythmia therapy]

Statistical models may be useful in order to evaluate antiarrhythmic treatment and to distinguish between drug efficacy and spontaneous variability of premature ventricular depolarizations. Analysis of variance and linear regression analysis have been both proposed for documenting antiarrhythmic efficacy. Holter/exercise approach has been designed as noninvasive method of drug testing. So far only one group has reported the long-term outcome of patients managed using this approach. Patients with malignant ventricular arrhythmias in which efficacy was achieved had better chance of surviving during follow-up than did the nonresponder patients. In addition to acute drug testing, chronic trials have been undertaken. One group has reported the long-term results in 124 drug trials and the efficacy was controlled by Holter monitoring. Cumulative probability of survival at 24 months was better for responders than for nonresponders (P less than 0.001). Perspective trials with antiarrhythmic drug are being concluded, such as CAPS and TEST. The results are imminent. Additional aspects to be considered are that critical suppression of premature ventricular depolarizations by Holter does not predict long-term remission of malignant ventricular arrhythmias. Comparison of follow-up results by programmed electrical stimulation and by Holter monitoring are not similar; retrospective non randomized studies show that programmed stimulation was superior to ambulatory monitoring in predicting drug efficacy, or that clinical outcome in patients whose regimen had been found ineffective by programmed stimulation, was as good as the outcome in patients effectively controlled by Holter monitoring.(ABSTRACT TRUNCATED AT 250 WORDS)