Determinants of induced sustained arrhythmias in survivors of out-of-hospital ventricular fibrillation

C. D. Swerdlow, G. H. Bardy, J. McAnulty, Jack Kron, J. T. Lee, E. Graham, J. Peterson, H. L. Greene

Research output: Contribution to journalArticle

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Abstract

We prospectively studied 196 consecutive survivors of out-of-hospital ventricular fibrillation (VF) not associated with acute myocardial infarction and 46 consecutive, control patients without prior ventricular arrhythmias. Programmed stimulation included two extrastimuli (S3 protocol) in all patients and three extrastimuli (S4 protocol) in the last 140 study patients and in all control patients. Sustained ventricular tachycardia (VT) or VF was not induced in any control patient. In study patients, logistic regression identified two independent predictors of induced, sustained VT for both S3 and S4 protocols: prior spontaneous, sustained VT (37 patients; p ≤ .001) and prior myocardial infarction (113 patients; p = .005). With the S3 protocol, sustained VT was induced in 54% of patients with both prior myocardial infarction and prior sustained VT vs 4% without either; with the S4 protocol, sustained VT was induced in 91% vs 13%, respectively. Eighty-three percent of induced VT episodes had a cycle length less than 300 msec, and all required termination by cardioversion or pacing. VF was induced only in survivors of out-of-hospital VF without prior, spontaneous, sustained VT (S3 protocol, 9%; S4 protocol, 24%) but not in study patients with prior sustained VT (S3, p = .10; S4, p = .05) or control patients (S3, p = .06; S4, p = .01). The mean coupling intervals of extrastimuli that induced VF were not significantly different from the intervals that induced sustained VT. These data indicate that prospective analysis of clinical variables can identify survivors of out-of-hospital VF with a very high and very low probability of induced sustained VT and that there is a significant correlation between induced VF and spontaneous out-of-hospital VF as the only clinical arrhythmia.

Original languageEnglish (US)
Pages (from-to)1053-1060
Number of pages8
JournalCirculation
Volume76
Issue number5
StatePublished - 1987
Externally publishedYes

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Ventricular Fibrillation
Ventricular Tachycardia
Survivors
Cardiac Arrhythmias
Myocardial Infarction
Electric Countershock
Logistic Models

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Swerdlow, C. D., Bardy, G. H., McAnulty, J., Kron, J., Lee, J. T., Graham, E., ... Greene, H. L. (1987). Determinants of induced sustained arrhythmias in survivors of out-of-hospital ventricular fibrillation. Circulation, 76(5), 1053-1060.

Determinants of induced sustained arrhythmias in survivors of out-of-hospital ventricular fibrillation. / Swerdlow, C. D.; Bardy, G. H.; McAnulty, J.; Kron, Jack; Lee, J. T.; Graham, E.; Peterson, J.; Greene, H. L.

In: Circulation, Vol. 76, No. 5, 1987, p. 1053-1060.

Research output: Contribution to journalArticle

Swerdlow, CD, Bardy, GH, McAnulty, J, Kron, J, Lee, JT, Graham, E, Peterson, J & Greene, HL 1987, 'Determinants of induced sustained arrhythmias in survivors of out-of-hospital ventricular fibrillation', Circulation, vol. 76, no. 5, pp. 1053-1060.
Swerdlow CD, Bardy GH, McAnulty J, Kron J, Lee JT, Graham E et al. Determinants of induced sustained arrhythmias in survivors of out-of-hospital ventricular fibrillation. Circulation. 1987;76(5):1053-1060.
Swerdlow, C. D. ; Bardy, G. H. ; McAnulty, J. ; Kron, Jack ; Lee, J. T. ; Graham, E. ; Peterson, J. ; Greene, H. L. / Determinants of induced sustained arrhythmias in survivors of out-of-hospital ventricular fibrillation. In: Circulation. 1987 ; Vol. 76, No. 5. pp. 1053-1060.
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abstract = "We prospectively studied 196 consecutive survivors of out-of-hospital ventricular fibrillation (VF) not associated with acute myocardial infarction and 46 consecutive, control patients without prior ventricular arrhythmias. Programmed stimulation included two extrastimuli (S3 protocol) in all patients and three extrastimuli (S4 protocol) in the last 140 study patients and in all control patients. Sustained ventricular tachycardia (VT) or VF was not induced in any control patient. In study patients, logistic regression identified two independent predictors of induced, sustained VT for both S3 and S4 protocols: prior spontaneous, sustained VT (37 patients; p ≤ .001) and prior myocardial infarction (113 patients; p = .005). With the S3 protocol, sustained VT was induced in 54{\%} of patients with both prior myocardial infarction and prior sustained VT vs 4{\%} without either; with the S4 protocol, sustained VT was induced in 91{\%} vs 13{\%}, respectively. Eighty-three percent of induced VT episodes had a cycle length less than 300 msec, and all required termination by cardioversion or pacing. VF was induced only in survivors of out-of-hospital VF without prior, spontaneous, sustained VT (S3 protocol, 9{\%}; S4 protocol, 24{\%}) but not in study patients with prior sustained VT (S3, p = .10; S4, p = .05) or control patients (S3, p = .06; S4, p = .01). The mean coupling intervals of extrastimuli that induced VF were not significantly different from the intervals that induced sustained VT. These data indicate that prospective analysis of clinical variables can identify survivors of out-of-hospital VF with a very high and very low probability of induced sustained VT and that there is a significant correlation between induced VF and spontaneous out-of-hospital VF as the only clinical arrhythmia.",
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AU - Bardy, G. H.

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AU - Kron, Jack

AU - Lee, J. T.

AU - Graham, E.

AU - Peterson, J.

AU - Greene, H. L.

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N2 - We prospectively studied 196 consecutive survivors of out-of-hospital ventricular fibrillation (VF) not associated with acute myocardial infarction and 46 consecutive, control patients without prior ventricular arrhythmias. Programmed stimulation included two extrastimuli (S3 protocol) in all patients and three extrastimuli (S4 protocol) in the last 140 study patients and in all control patients. Sustained ventricular tachycardia (VT) or VF was not induced in any control patient. In study patients, logistic regression identified two independent predictors of induced, sustained VT for both S3 and S4 protocols: prior spontaneous, sustained VT (37 patients; p ≤ .001) and prior myocardial infarction (113 patients; p = .005). With the S3 protocol, sustained VT was induced in 54% of patients with both prior myocardial infarction and prior sustained VT vs 4% without either; with the S4 protocol, sustained VT was induced in 91% vs 13%, respectively. Eighty-three percent of induced VT episodes had a cycle length less than 300 msec, and all required termination by cardioversion or pacing. VF was induced only in survivors of out-of-hospital VF without prior, spontaneous, sustained VT (S3 protocol, 9%; S4 protocol, 24%) but not in study patients with prior sustained VT (S3, p = .10; S4, p = .05) or control patients (S3, p = .06; S4, p = .01). The mean coupling intervals of extrastimuli that induced VF were not significantly different from the intervals that induced sustained VT. These data indicate that prospective analysis of clinical variables can identify survivors of out-of-hospital VF with a very high and very low probability of induced sustained VT and that there is a significant correlation between induced VF and spontaneous out-of-hospital VF as the only clinical arrhythmia.

AB - We prospectively studied 196 consecutive survivors of out-of-hospital ventricular fibrillation (VF) not associated with acute myocardial infarction and 46 consecutive, control patients without prior ventricular arrhythmias. Programmed stimulation included two extrastimuli (S3 protocol) in all patients and three extrastimuli (S4 protocol) in the last 140 study patients and in all control patients. Sustained ventricular tachycardia (VT) or VF was not induced in any control patient. In study patients, logistic regression identified two independent predictors of induced, sustained VT for both S3 and S4 protocols: prior spontaneous, sustained VT (37 patients; p ≤ .001) and prior myocardial infarction (113 patients; p = .005). With the S3 protocol, sustained VT was induced in 54% of patients with both prior myocardial infarction and prior sustained VT vs 4% without either; with the S4 protocol, sustained VT was induced in 91% vs 13%, respectively. Eighty-three percent of induced VT episodes had a cycle length less than 300 msec, and all required termination by cardioversion or pacing. VF was induced only in survivors of out-of-hospital VF without prior, spontaneous, sustained VT (S3 protocol, 9%; S4 protocol, 24%) but not in study patients with prior sustained VT (S3, p = .10; S4, p = .05) or control patients (S3, p = .06; S4, p = .01). The mean coupling intervals of extrastimuli that induced VF were not significantly different from the intervals that induced sustained VT. These data indicate that prospective analysis of clinical variables can identify survivors of out-of-hospital VF with a very high and very low probability of induced sustained VT and that there is a significant correlation between induced VF and spontaneous out-of-hospital VF as the only clinical arrhythmia.

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