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The Signal Averaged Electrocardiogram and Programmed Stimulation in Patients with Complex Ventricular Arrhythmias
Author(s) -
TURITTO GIOIA,
ELSHERIF NABIL
Publication year - 1990
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1990.tb06959.x
Subject(s) - medicine , cardiology , ventricular fibrillation , signal averaged electrocardiogram , ventricular tachycardia , ejection fraction , coronary artery disease , sudden cardiac death , electrocardiography , sudden death , population , anesthesia , heart failure , environmental health
TURITO, G., ET AL.: The Signal Averaged Electrocardiogram and Programmed Stimulation in Patients with Complex Ventricular Arrhythmias. The signal averaged electrocardiogram (SA‐ECG), programmed electrical stimulation (PES), and left ventricular ejection fraction (EF) studies were utilized for risk stratification and management of patients with complex ventricular arrhythmias and nonsustained ventricular tachycardia (VT). The study population included 90 patients (63 with coronary artery disease and 27 with dilated cardiomyopathy). Sustained monomorphic VT was induced in 22 cases (24%), ventricular fibrillation (VF) in 10 (11%), and no sustained VT/VF in 58 (64%). An abnormal SA‐ECG was recorded in 23 patients (26%) and was more common in patients with than in those without induced sustained VT (68% vs 12%, p < 0.0001). None of 33 patients with normal SA‐ECG and EF ≥ 40% had induced VT. Patients were followed‐up for 2.5 ± 0.8 years off antiarrhythmic therapy, unless they had induced sustained VT. The 3‐year sudden death rate was 19% in the group with induced sustained VT, 0 in that with induced VF, and 9% in that without induced VT/VF (P = NS). The 3‐year total cardiac mortality was higher in patients with than in those without EF < 40% (27% vs 7%, p < 0.05). It is concluded that patients with organic heart disease and spontaneous nonsustained VT may not need PES or antiarrhythmic therapy if SA‐ECG is normal and EF is ≥ 40%, since their risk of induced VT and sudden death is low. On the other hand, patients with abnormal SA‐ECG and/or EF < 40% may require PES, since their risk for induced VT is high. Antiarrhythmic therapy may also be considered in these patients. (PACE, Vol. 13, December, Part II 1990)