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Determinants of survival in patients with malignant ventricular arrhythmia associated with coronary artery disease
S Lampert1, B Lown, T B Graboys
1Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115.
Insights
Sudden cardiac death is a significant risk for patients with coronary artery disease and malignant ventricular arrhythmias. Suppressing ventricular tachycardia through monitoring and exercise testing indicates improved survival rates.
Area of Science:
- Cardiology
- Electrophysiology
- Clinical Medicine
Background:
- Patients with coronary artery disease (CAD) and malignant ventricular arrhythmias (VAs) face long-term survival challenges.
- Malignant VAs include noninfarction ventricular fibrillation (VF) and hemodynamically compromising ventricular tachycardia (VT).
Purpose of the Study:
- To analyze long-term survival data in patients with CAD and malignant VAs.
- To identify independent predictors of sudden cardiac death (SCD) in this patient population.
Main Methods:
- Analysis of long-term survival data (up to 9 years) in 161 patients with CAD and malignant VAs.
- Life-table analysis, ambulatory monitoring, exercise testing, and electrophysiologic testing were employed.
- Univariate and multivariate regression analyses were used to identify predictors of SCD.
Main Results:
- Sudden death accounted for 63% of the 57 total deaths in the study group.
- The annual sudden death rate was 10% in the first year and 7% in subsequent years.
- Independent predictors of SCD included rales, VT runs during exercise testing, congestive heart failure history, and premature beats on Holter monitoring.
Conclusions:
- Suppression of repetitive arrhythmias on Holter monitoring and exercise testing is a marker for improved survival.
- Identifying independent predictors aids in risk stratification and management of patients with malignant VAs.
Abstract:
The long-term survival data in patients with coronary artery disease and a history of malignant ventricular arrhythmia, defined as noninfarction ventricular fibrillation (VF) or hemodynamically compromising ventricular tachycardia (VT) followed for up to 9 years, were analyzed. In this group of 161 patients there was a total of 57 deaths, of which 35 (63%) were sudden. Life-table analysis demonstrated a 10% sudden death rate for all patients in the first year and a 7% annual rate in the subsequent 4 years. In patients managed noninvasively, the overall mortality rate was 27% over 9 years, or 3% per year. Suppression of ventricular tachycardia on both ambulatory monitoring and exercise testing was associated with improved survival. In patients evaluated by electrophysiologic testing the sudden death rate was 1.4% per year over an average of 5 years. This survival rate was not different compared with the noninvasive group (p = 0.09). Measures of left ventricular dysfunction and the frequency of ventricular arrhythmia before and after drug therapy were associated with a risk of sudden cardiac death by univariate analysis. Multivariate regression analysis identified 4 variables as independent predictors of sudden cardiac death: rales (p = 0.009), the number of runs of VT during exercise testing while receiving antiarrhythmic drug therapy (p = 0.0003), a history of congestive heart failure (p = 0.0009) and the number of premature beats on Holter monitoring (p = 0.01). These findings support the concept that suppression of repetitive arrhythmia on Holter monitor and exercise testing is a marker for improved survival among patients with malignant ventricular arrhythmia.(ABSTRACT TRUNCATED AT 250 WORDS)