Clinical usefulness of electrophysiologic testing in patients with ventricular tachycardia and chronic chagasic cardiomyopathy treated with amiodarone or sotalol

Luiz R. Leite, Guilherme Fenelon, Aloyr Simoes, Georgia G. Silva, Paul Andrew Friedman, A. A V De Paola

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Tachycardia and Chagasic Cardiomyopathy. Introduction: This study assessed the role of electrophysiologic testing to identify therapeutic strategies for the treatment of patients with sustained ventricular tachycardia (VT) and chronic chagasic cardiomyopathy treated with amiodarone or sotalol. Methods and Results: One hundred fifteen patients [69 men (60%); mean age 52 ± 10 years] with chagasic cardiomyopathy presenting with symptomatic VT were studied after loading with Class III antiarrhythmic drugs; 78 had a history of sustained VT, and 37 with symptomatic nonsustained VT had sustained VT induced at baseline electrophysiologic study. All but 12 patients also underwent baseline electrophysiologic study. Mean left ventricular ejection fraction was 0.49 ± 0.14. Based on results of electrophysiologic study after loading with Class III drugs, patients were divided into three groups: group 1 (n = 23) had no sustained VT induced; group 2 (n = 45) had only tolerated sustained VT induced; and group 3 (n = 47) had hemodynamically unstable sustained VT induced. After a mean follow-up of 52 ± 32 months, total mortality rate was 39.1%; it was significantly higher in group 3 than in groups 2 and 1 [69%, 22.2%, and 26%, respectively, P < 0.0001, hazard ratio (HR) 10.4, 95% confidence interval (CI) 3.8, 21.8]. There was no significant difference in total mortality rate between groups 1 and 2 (P = 0.40, HR 1.5, 95% CI 0.75, 4.58). Cardiac mortality and sudden cardiac death rates also were higher in group 3 patients. Conclusion: In patients with chagasic cardiomyopathy and sustained VT, electrophysiologic testing can predict long-term efficacy of Class III antiarrhythmic drugs. This may help in the selection of patients for implantable cardioverter defibrillator therapy.

Original languageEnglish (US)
Pages (from-to)567-573
Number of pages7
JournalJournal of Cardiovascular Electrophysiology
Volume14
Issue number6
DOIs
StatePublished - Jun 1 2003

Fingerprint

Sotalol
Amiodarone
Ventricular Tachycardia
Cardiomyopathies
Mortality
Anti-Arrhythmia Agents
Confidence Intervals
Implantable Defibrillators
Sudden Cardiac Death
Tachycardia
Stroke Volume
Patient Selection
Therapeutics

Keywords

  • Amiodarone
  • Chronic chagasic cardiomyopathy
  • Electrophysiologic study
  • Sotalol
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Clinical usefulness of electrophysiologic testing in patients with ventricular tachycardia and chronic chagasic cardiomyopathy treated with amiodarone or sotalol. / Leite, Luiz R.; Fenelon, Guilherme; Simoes, Aloyr; Silva, Georgia G.; Friedman, Paul Andrew; De Paola, A. A V.

In: Journal of Cardiovascular Electrophysiology, Vol. 14, No. 6, 01.06.2003, p. 567-573.

Research output: Contribution to journalArticle

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abstract = "Tachycardia and Chagasic Cardiomyopathy. Introduction: This study assessed the role of electrophysiologic testing to identify therapeutic strategies for the treatment of patients with sustained ventricular tachycardia (VT) and chronic chagasic cardiomyopathy treated with amiodarone or sotalol. Methods and Results: One hundred fifteen patients [69 men (60{\%}); mean age 52 ± 10 years] with chagasic cardiomyopathy presenting with symptomatic VT were studied after loading with Class III antiarrhythmic drugs; 78 had a history of sustained VT, and 37 with symptomatic nonsustained VT had sustained VT induced at baseline electrophysiologic study. All but 12 patients also underwent baseline electrophysiologic study. Mean left ventricular ejection fraction was 0.49 ± 0.14. Based on results of electrophysiologic study after loading with Class III drugs, patients were divided into three groups: group 1 (n = 23) had no sustained VT induced; group 2 (n = 45) had only tolerated sustained VT induced; and group 3 (n = 47) had hemodynamically unstable sustained VT induced. After a mean follow-up of 52 ± 32 months, total mortality rate was 39.1{\%}; it was significantly higher in group 3 than in groups 2 and 1 [69{\%}, 22.2{\%}, and 26{\%}, respectively, P < 0.0001, hazard ratio (HR) 10.4, 95{\%} confidence interval (CI) 3.8, 21.8]. There was no significant difference in total mortality rate between groups 1 and 2 (P = 0.40, HR 1.5, 95{\%} CI 0.75, 4.58). Cardiac mortality and sudden cardiac death rates also were higher in group 3 patients. Conclusion: In patients with chagasic cardiomyopathy and sustained VT, electrophysiologic testing can predict long-term efficacy of Class III antiarrhythmic drugs. This may help in the selection of patients for implantable cardioverter defibrillator therapy.",
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AU - Friedman, Paul Andrew

AU - De Paola, A. A V

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