<HTML><BODY style="word-wrap: break-word; -khtml-nbsp-mode: space; -khtml-line-break: after-white-space; "><DIV><DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Dr. Serge Boveda from France asks</FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">- Is EP study (programmed ventricular pacing) still valuable for risk stratification in sudden cardiac death?</FONT></DIV></DIV><DIV><P class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Dr. Alfred Buxton from U.S.A. answers</FONT></P><P class="MsoNormal"><FONT class="Apple-style-span" face="Arial">- 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. </FONT></P><P class="MsoNormal"><FONT class="Apple-style-span" face="Arial">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.</FONT></P><P class="MsoNormal"><FONT class="Apple-style-span" face="Arial">References: </FONT></P><P class="MsoNormal"><FONT class="Apple-style-span" face="Arial">1. Buxton AE, Hafley GE, Lee KL, Gold MR, Packer DL, Lehmann MH, Josephson</FONT></P><P class="MsoNormal"><FONT class="Apple-style-span" face="Arial">ME, Wyse DG, Fisher JD, Prystowsky EN, Talajic MR, Pires LA, for the MUSTT</FONT></P><P class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Investigators. Relation of Ejection Fraction and Inducible Ventricular</FONT></P><P class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Tachycardia to Mode of Death in Patients with Coronary Artery Disease. An</FONT></P><P class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Analysis of Patients Enrolled in the Multicenter Unsustained Tachycardia</FONT></P><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Trial. Circulation 2002;106:2466-2472.</FONT></DIV><P class="MsoNormal"><FONT class="Apple-style-span" face="Arial">2. Buxton AE, Lee KL, Hafley GE, Prystowsky EN, Josephson ME, Fisher JD,</FONT></P><P class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Gold MR, The MUSTT Investigators. A Simple Model Using the MUSTT Database</FONT></P><P class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Can Stratify Total Mortality and Sudden Death Risk of Coronary Disease</FONT></P><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Patients. J Am Coll Cardiol 43:Suppl-425A, 2004.</FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial"> </FONT></DIV><P class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Alfred E. Buxton, M.D.</FONT></P><P class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Ruth and Paul Levinger Professor of Medicine</FONT></P><P class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Director, Division of Cardiology</FONT></P><P class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Director, Arrhythmia Services and Electrophysiology Laboratory</FONT></P><P class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Brown Medical School</FONT></P><P class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Cardiology Division </FONT></P><P class="MsoNormal"><FONT class="Apple-style-span" face="Arial">2 Dudley Street, Suite 360</FONT></P><P class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Providence, RI 02905</FONT></P><P class="MsoNormal"><FONT class="Apple-style-span" face="Arial">401 444-5328 (phone)</FONT></P><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial"><A href="mailto:Alfred_Buxton@Brown.edu">Alfred_Buxton@Brown.edu</A></FONT></DIV></DIV></DIV><FONT class="Apple-style-span" face="Arial"><BR></FONT><DIV><DIV><FONT class="Apple-style-span" face="Arial">--</FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial">Dr. Sergio Dubner</FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial">President of Scientific Committee</FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial"><BR></FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial">Dr. Edgardo Schapachnik</FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial">President of Steering Committee</FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><FONT class="Apple-style-span" face="Arial"><BR class="Apple-interchange-newline"></FONT></DIV><FONT class="Apple-style-span" face="Arial"><BR></FONT></BODY></HTML>