Evaluation of end points of serial drug testing in patients with sustained ventricular tachycardia after healing of acute myocardial infarction

Abstract

Serial electrophysiologic drug testing was used to guide antiarrhythmic therapy in a consecutive series of 150 patients with clinical sustained ventricular tachycardia (VT) or cardiac arrest and inducible monomorphic VT. All patients had coronary artery disease and a history of myocardial infarction. For patients with clinical sustained VT, drug responders and partial drug responders (VT slowed by drug to rate <150 beats/min, with systolic blood pressure ≥90 mm Hg) had similar total mortality rates (2-year actuarial survival 100% and 94%, p = NS), which were statistically different from that or patients with drug inefficacy (2-year survival 67%). Partial drug responders had high arrhythmia recurrence rates, similar to those of patients with drug inefficacy. For cardiac arrest survivors, the results of electrophysiologically guided drug testing did not predict prognosis. Patients with a change in mode or VT induction during antiarrhythmic therapy had a favorable prognosis (no deaths during follow-up).