Results of electrophysiologic testing and long-term prognosis in patients with coronary artery disease and aborted sudden death

The purpose of this study was to evaluate the results of electrophysiologic testing and the long-term prognosis of 56 patients with coronary artery disease who presented with aborted sudden death unrelated to acute myocardial infarction. The mean age of the patients was 62 ± 8 years (± standard deviation) and 48 were men. The mean left ventricular ejection fraction was 0.34 ± 0.16. During the baseline electrophysiology test, sustained monomorphic ventricular tachycardia (VT) was inducible in 22 patients who then underwent electropharmacologic testing: 11 patients were treated with antiarrhythmic drugs that suppressed the induction of VT or resulted in the VT becoming hemodynamically stable; 10 patients who failed drug testing received an automatic implantable cardioverter/defibrillator (AICD); one patient underwent endocardial resection. Among 34 patients who did not have inducible sustained VT, a precipitant of cardiac arrest (severe ischemia, proarrhythmia) was identified and was corrected in 9 of 34. An AICD was recommended in the remaining 25 patients; however, nine patients refused and were treated empirically with antiarrhythmic drugs. The mean follow-up was 22 ± 12 months. The 2-year actuarial incidence of sudden death was 31% in patients who were treated with drugs based on the results of electropharmacologic testing, 26% in patients who were treated with antiarrhythmic drugs on an empiric basis, 0% among patients in whom a correctable etiology for the cardiac arrest was identified, and 9% among patients who underwent implantation of an AICD. The 3-year actuarial incidence of sudden death among the 20 patients treated with antiarrhythmic drugs was 53%, compared with 9% among the 26 patients who underwent AICD implantation (p = 0.03). In conclusion, antiarrhythmic therapy, whether guided by electrophysiologic testing or administered on an empiric basis, is associated with a high incidence of recurrent sudden death in patients with coronary artery disease and aborted sudden death. Implantation of an AICD may be advisable in all patients with coronary artery disease and aborted sudden death in whom a correctable precipitant cannot be identified.