Circulation, Vol 58, 986-997, Copyright © 1978 by American Heart Association
LN Horowitz, ME Josephson, A Farshidi, SR Spielman, EL Michelson and AM Greenspan
Twenty patients with recurrent sustained ventricular tachycardia (VT)
underwent serial electrophysiological studies (EPS) 1) to determine the
predictive value of the EPS in the selection of antiarrhythmic therapy, and
2) to establish the therapeutic efficacy of available antiarrhythmic
agents. In each patient VT could be reproducibly initiated by programmed
stimulation. After control EPS, the effects of several drugs (lidocaine,
procainamide, quinidine, disopyramide and diphenylhydantoin) on the ability
to initiate VT were assessed. An oral regimen was chosen on the basis of
acute EPS and its effectiveness was evaluated by repeat EPS in 24--72
hours. Blood levels achieved acutely were used as guidelines to chronic
therapy. In 14 patients the initiation of VT was prevented by the acute
administration of one or more agents. In 13 of these patients, a chronic
oral regimen based on these results prevented recurrence of VT with a
three- to 27-month follow-up. In the remaining patient, oral therapy could
not achieve blood levels of procainamide shown to be effective
intravenously, and VT recurred. In six patients no single drug or drug
combination was effective during acute EPS, and VT recurred in all while on
therapy with the agent shown to make initiation of VT most difficult.
Procainamide prevented VT in nine patients; quinidine in three patients;
lidocaine in three patients; diphenylhydantoin in two patients; and
disopyramide in one patient. The mean duration of EPS studies was 4.5 days.
This study suggests that serial EPS provides rapid identification of
successful antiarrhythmic therapy and can predict in which patients
conventional therapy would be ineffective, thereby identifying patients
requiring more aggressive modes of therapy.
ARTICLES
Recurrent sustained ventricular tachycardia 3. Role of the electrophysiologic study in selection of antiarrhythmic regimens
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