Prospective comparison of Holter monitoring and electrophysiologic study in patients with coronary artery disease and sustained ventricular tachyarrhythmias

Abstract

Baseline 24-hour Holter monitoring (HM) and electrophysiologic study (EPS) were compared in 43 consecutive patients with coronary artery disease who had sustained ventricular tachyarrhythmias to determine the fraction of patients in whom each could be performed and the fraction in whom each could be used to guide therapy. Patients were excluded from HM if sustained ventricular tachycardia (VT) requiring termination occurred and from EPS if heart failure was sufficiently severe to cause excessive risk. More patients completed EPS than HM (90% vs 71%), but this difference was not statistically significant (p = 0.12). Overall, HM detected arrhythmias suitable for antiarrhythmic drug assessment in 50% of patients: 30 or more ventricular premature complexes (VPCs) per hour in 50%, 10 or more VPC pairs in 44%, 5 or more runs in 19%, and 10 or more pairs and runs in 44%. Sustained monomorphic VT suitable for electropharmacologic testing was induced for electropharmacologic testing was induced at EPS in 82% (p = 0.003 vs HM). Drug efficacy could be assessed in 70% of patients evaluated by HM, compared with 96% evaluated by EPS (p = 0.02). Thus, in consecutive coronary patients with sustained ventricular tachyarrhythmias, EPS could be used to guide therapy more frequently than HM.