Prevention of recurrent sudden cardiac arrest: role of provocative electropharmacologic testing

David G. Benditt, D. Woodrow Benson, George J. Klein, Marc R. Pritzker, Jolene M. Kriett, Robert W. Anderson

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90 Scopus citations

Abstract

This study evaluates the usefulness of serial provocative electropharmacologic testing for predicting the efficacy of prophylactic antiarrhythmic treatment regimens in patients resuscitated from sudden cardiac arrest in the absence of acute myocardial infarction. Testing was carried out in 34 consecutive patients (28 men and 6 women) who required cardiopulmonary resuscitation and direct current countershock for treatment of primary ventricular fibrillation (28 patients), ventricular tachycardia (5 patients) or excessively rapid heart rate during atrial fibrillation with preexcitation (1 patient). In 8 (24%) of the 34 patients, drug testing either was not feasible because of absence of inducible arrhythmia or was incomplete because of patient withdrawal from study; and 3 of these 8 patients had recurrent sudden cardiac arrest within 10 to 19 months. In an additional five patients, treatment regimens failed to prevent initiation of sustained ventricular tachyarrhythmias in the catheterization laboratory, and two of these five patients had cardiac arrest recurrences within 2 weeks to 25 months of follow-up. In the remaining 21 (62%) of the 34 patients, including 3 patients with preexcitation syndrome, a drug regimen or surgical treatment, or both, was found that prevented inducible life-threatening tachyarrhythmias in the laboratory. Subsequently, only 1 (5%) of these 21 patients died suddenly within a 7 to 38 month (mean ± standard deviation, 18 ± 8.3) follow-up period. Thus, provocative electropharmacologic testing appears to be useful in predicting response to therapy in survivors of sudden cardiac arrest.

Original languageEnglish (US)
Pages (from-to)418-425
Number of pages8
JournalJournal of the American College of Cardiology
Volume2
Issue number3
DOIs
StatePublished - 1983

Bibliographical note

Funding Information:
From the Departments of Medicine, Pediatrics and Surgery, University of Minnesota, Minneapolis, Minnesota* and the Department of Medicine, University of Western Ontario, London, Ontario, Canada.t This work was supported in part by a Fellowship Grant (M.R P.) from the Amencan Heart Association, Mmnesota Affiliate, and was presented in part at the American Heart Association 55th Scientific SeSSIOns, Dallas, Texas, 1982. Manuscript received October 29, 1982; revised manuscript received Apnl 11, 1983, accepted April 15, 1983.

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