Management of recurrent ventricular tachycardia: Economic impact of therapeutic alternatives

Abstract

The clinical and economic results of antiarrhythmic therapy selected on the basis of electrophysiologic (EP) studies in patients with recurrent ventricular tachycardia (VT) were examined and compared with previously administered empiric therapy. Twenty-nine patients with recurrent VT and organic heart disease, aged 39 to 78 years (mean 59 ± 11) were evaluated. All patients had empiric therapy before EP studies and EP-based therapy after EP evaluation. Hospital records were analyzed from arrhythmia diagnosis 1 to 39 months (mean 7.5 ± 10.4) before EP evaluation until completion of follow-up 1 to 20 months (mean 13.3 ± 7.4) after EP studies. Clinical efficacy was assessed by comparing actual arrhythmic deaths or recurrences during EP-based therapy with predicted values on empiric therapy. Charges based on diagnosis-related groupings for empiric and EP-based therapy were compared. Charges for EP evaluation were included in the calculation for EP-based therapy. During empiric therapy, 1 to 7 unsuccessful drug trials (mean 3.7 ± 1.6) were performed, with arrhythmia recurrences noted in all patients during a mean 7.5-month VT duration. Twenty-seven of 29 patients required 1 to 70 electrical terminations. There were 64 hospitalizations (mean 2.1 ± 1.7) with a total length of hospital stay of 913 days (mean 31.0 ± 19.9). EP evaluation required 90 EP procedures (mean 3.0 ± 1.5) with a length of stay of 690 days (mean 23.8 ± 12.0). During a follow-up period of 1 to 26.5 months (13.3 ± 7.4) on EP-based therapy, 1 patient died suddenly. There were 5 repeat hospitalizations for adverse effects with a total length of stay of 48 days (mean 1.7 ± 5.1). There is a significant reduction in arrhythmia recurrences and sudden death (p < 0.05) and hospital charges (p < 0.01) with EP-based therapy compared with empiric therapy. We conclude that EP-based therapy has favorable clinical and economic results in patients with recurrent VT.