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Abstract
Nonsustained ventricular tachycardia (VT) in the late period (7 to 21 days) after
myocardial infarction (MI) is reported to be a predictor of sudden death. Patients
with 3-beai VT on Holter monitoring in the late infarction period would be suspected
to demonstrate electrical instability on electrophysiologic studies. Forty-seven patients
were identified as having at least 3-beat VT on Holter monitoring. Eighteen patients
refused electrophysiologic studies or were not referred. Eight patients died; 3 were
sudden deaths in 13 ± 5 months, a 17% incidence. Twenty-nine patients underwent invasive
electrophysiologic studies and 28 had inducible VT, 18 sustained and 10 nonsustained.
Lorcainide prevented VT induction in 21 of the 28 patients, whereas 12 of the 22 patients
studied on procainamide were protected. Lidocaine, tested in 21 patients, prevented
VT induction in only 5. Lorcainide and procainamide prolonged refractoriness in those
patients protected at programmed electrical stimulation (PES), whereas the QT interval
was prolonged in patients in whom VT could still be induced. Twenty-seven of the 28
patients were placed on drugs predicted to be effective by PES studies, 19 on lorcainide.
After a mean follow-up of 12.5 ± 4 months the patient with noninducible arrhythmia
is alive and 26 of the 28 patients with inducible arrhythmia are alive and well. Two
patients died, 1 of stroke and 1 of pump failure after a second MI. No sudden deaths
were observed in this group. Two patients had breakthrough arrhythmias and were treated
by alternative antiarrhythmic therapy that was also effective on initial electrophysiologic
studies. Thus, PES studies after MI are safe and may be an effective way to determine
therapy for patients in the post-MI period, identified at high risk for sudden death.
Furthermore, lorcainide appears to be safe and effective when its selection is guided
by electrophysiologic studies.
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Article info
Footnotes
☆This study was supported in part by a grant from Janssen R & D, Inc.
Identification
Copyright
© 1984 Published by Elsevier Inc.
