Prognostic implications of complex ventricular ectopy in patients with and without structural heart disease. A study...

Area of Science:

• Cardiology
• Electrophysiology
• Arrhythmology

Background:

• Complex ventricular ectopy (Lown grade IVa, IVb) requires risk stratification.
• Programmed electrical stimulation (PES) is used to assess arrhythmia inducibility.

Purpose of the Study:

• To evaluate the role of PES in identifying patients with complex ventricular ectopy at risk for sudden cardiac death.
• To assess the efficacy of anti-arrhythmic drug therapy in patients with inducible ventricular tachycardia.

Main Methods:

• Fifty-six patients with complex ventricular ectopy underwent 48-hour monitoring and PES.
• Patients were categorized into inducible (Group I) and non-inducible (Group II) ventricular tachycardia groups.
• Follow-up was conducted for 34 ± 10 months to assess outcomes.

Main Results:

• Inducible ventricular tachycardia (Group I) was associated with significantly higher left ventricular dysfunction (ejection fraction <40%) and sudden death incidence (36.3% vs 6.6%).
• Patients without structural heart disease and non-inducible VT had excellent prognoses.
• Anti-arrhythmic drug therapy in Group I did not reduce, and may have increased, sudden death risk.

Conclusions:

• PES can identify a high-risk subset of patients with structural heart disease and complex ventricular ectopy.
• Inducible ventricular tachycardia on PES is a marker for poor prognosis and increased sudden death risk.
• Anti-arrhythmic drugs may not benefit, and could potentially harm, patients with inducible VT.