[SCD-FORUM] EXPERTS ASK, EXPERTS ANSWER

[SCD Symposium]

Dr. Serge Boveda from France asks

- Is EP study (programmed ventricular pacing) still valuable for risk  
stratification in sudden cardiac death?
Dr. Alfred Buxton from U.S.A. answers

- Yes - Programmed stimulation can add valuable information in  
patients with coronary disease for whom ICD implant is considered in  
the following situation:  Patients with ejection fraction >30%, that  
do not have symptomatic heart failure, left bundle branch block, or  
non-specific intraventricular conduction delay are at very low risk  
for sudden death (<3% over 2 years) if they do not have inducible VT  
at EP testing.  The presence of inducible VT elevates that risk  
considerably.

The model referred to in reference 2 below also suggests that even in  
patients whose EF is <= 30%, if there is no symptomatic heart  
failure, left bundle branch block, or non-specific intraventricular  
conduction delay the risk of sudden death is 3.4% over 2 years.  This  
combination of findings was observed in approximately 25% of patients  
enrolled in the MUSTT study.  In these patients, finding inducible VT  
would significantly elevate risk of sudden death.  The model referred  
to in reference 2 will require prospective testing before it can be  
advocated for general use.

References:

1.  Buxton AE, Hafley GE, Lee KL, Gold MR, Packer DL, Lehmann MH,  
Josephson

ME, Wyse DG, Fisher JD, Prystowsky EN, Talajic MR, Pires LA, for the  
MUSTT

Investigators.  Relation of Ejection Fraction and Inducible Ventricular

Tachycardia to Mode of Death in Patients with Coronary Artery  
Disease.  An

Analysis of Patients Enrolled in the Multicenter Unsustained Tachycardia

Trial.  Circulation 2002;106:2466-2472.
2.  Buxton AE, Lee KL, Hafley GE, Prystowsky EN, Josephson ME, Fisher  
JD,

Gold MR, The MUSTT Investigators.  A Simple Model Using the MUSTT  
Database

Can Stratify Total Mortality and Sudden Death Risk of Coronary Disease

Patients.  J Am Coll Cardiol 43:Suppl-425A, 2004.

Alfred E. Buxton, M.D.

Ruth and Paul Levinger Professor of Medicine

Director, Division of Cardiology

Director, Arrhythmia Services and Electrophysiology Laboratory

Brown Medical School

Cardiology Division

2 Dudley Street, Suite 360

Providence, RI 02905

401 444-5328 (phone)

Alfred_Buxton at Brown.edu

--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee




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