Recurrence of malignant ventricular arrhythmia after antiarrhythmic drug withdrawal

Selection of an antiarrhythmic drug program by noninvasive means for patients with malignant ventricular arrhythmia has not been demonstrated to be the decisive factor in promoting enhanced long-term survival. Twenty-four patients (16 men, mean age 56 years) with a history of either recurrent ventricular tachycardia or non-infarction ventricular fibrillation were studied after antiarrhythmic therapy had been discontinued. All patients had been symptom-free on a tailored drug program for a mean of 31 months. Twenty of the 24 patients were hospitalized and underwent systematic drug withdrawal to assess continued need for therapy or because of intolerable side effects. In 4 patients, medication was discontinued either on their own or by their local physician. Recurrence after drug withdrawal was defined as either recurrence of the presenting arrhythmia (ventricular tachycardia or ventricular fibrillation) (12 patients) or reappearance of repetitive arrhythmia during Holter monitoring or exercise stress testing comparable to pretreatment levels (11 patients). The clinical arrhythmia recurred in 12 patients. Nine patients had a cardiac arrest. These data document the high recurrence rate of malignant ventricular arrhythmia on cessation of a proved antiarrhythmic program. They further support the concept that patients with life-threatening arrhythmia can be protected from recurrence by noninvasive methods of drug selection that are guided by suppression of advanced forms of ventricular premature complexes.