[Ventricular tachycardia of dilated cardiomyopathies]

Patients with dilated cardiomyopathy often have unsustained VT (15 to 60% of cases) but sustained VT is much less common (0 to 10% of cases). The predictive value of sudden death of VT in Holter monitoring is not unanimously accepted. Therefore, it appears that, in patients with non-symptomatic VT, it is the degree of left ventricular dysfunction which is the best predictive factor of mortality because Holter monitoring, signal averaged ECG and programmed stimulation have a low positive predictive value although their cumulated negative predictive value seems to be very good. Programmed ventricular stimulation should be proposed to patients considered to be at high risk of sudden death, presenting with symptomatic unsustained VT or sustained VT. Approximately 3 out of 4 of these arrhythmias will be inducible and benefit from this method for orientating the choice of treatment. In these high risk subjects about 1 in 3 will be satisfactorily protected by antiarrhythmic drug therapy: non-inducible patients from the outset and those remaining inducible despite antiarrhythmic therapy remain at high risk of sudden death. This group of patients probably represents the best indication of implantable cardioverter defibrillators.