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(Circulation. 2001;103:244.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

"Stable" Ventricular Tachycardia Is Not a Benign Rhythm

Insights From the Antiarrhythmics Versus Implantable Defibrillators (AVID) Registry

Merritt H. Raitt, MD; Ellen Graham Renfroe, RN; Andrew E. Epstein, MD; John H. McAnulty, MD; Paul Mounsey, MD; Jonathan S. Steinberg, MD; Scott E. Lancaster, MS; Ram L. Jadonath, MD; Alfred P. Hallstrom, PhD; for the AVID Investigators

From the Portland VA Medical Center, Portland, Ore (M.H.R.); University of Washington, Seattle (E.G.R., S.E.L., A.P.H.); University of Alabama, Birmingham (A.E.E.); Oregon Health Sciences University, Portland (J.H.M.); University of Virginia Medical Center, Charlottesville (P.M.); St. Luke’s-Roosevelt Hospital Center, New York, NY (J.S.S.); and North Shore University Hospital, Manhasset, NY (R.L.J.).

Correspondence to AVID Clinical Trial Center, 1107 NE 45th St, Room 505, Seattle, WA 98105. E-mail avidctc{at}u.washington.edu

Background—Sustained ventricular tachycardia (VT) can be unstable, can be associated with serious symptoms, or can be stable and relatively free of symptoms. Patients with unstable VT are at high risk for sudden death and are best treated with an implantable defibrillator. The prognosis of patients with stable VT is controversial, and it is unknown whether implantable cardioverter-defibrillator therapy is beneficial.

Methods and Results—Screening for the Antiarrhythmics Versus Implantable Defibrillators (AVID) trial identified patients with both stable and unstable VT. Both groups were included in a registry, and their clinical characteristics and discharge treatments were recorded. Mortality data were obtained through the National Death Index. The mortality in 440 patients with stable VT tended to be greater than that observed in 1029 patients presenting with unstable VT (33.6% versus 27.6% at 3 years; relative risk [RR]=1.22; P=0.07). After adjustment for baseline and treatment differences, the RR was little changed (RR=1.25, P=0.06).

Conclusions—Sustained VT without serious symptoms or hemodynamic compromise is associated with a high mortality rate and may be a marker for a substrate capable of producing a more malignant arrhythmia. Implantable cardioverter-defibrillator therapy may be indicated in patients presenting with stable VT.

Key Words: death, sudden • tachycardia • cardioversion • defibrillation

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