[Prognostic factors after sustained ventricular fibrillation or tachycardia. A multivariate study apropos of 160 cases]. / Facteurs pronostiques après fibrillation ou tachycardie ventriculaire soutenue. Etude multivariée à propos de 160 observations.

The authors analysed survival of 160 patients (121 men and 31 women; average age 57.2 +/- 12.5 years; follow-up 29 +/- 20 months) treated for malignant ventricular arrhythmias (sustained ventricular tachycardia, ventricular fibrillation, syncope with inducible ventricular tachycardia). The therapeutic evaluation was frequently invasive (145 patients underwent at least programmed ventricular stimulation, 108 patients underwent full endocavitary electrophysiological studies) and non-pharmacological therapy was widely used (defibrillator n = 44; antiarrhythmic surgery n = 28; ablative procedures n = 19; transplantation n = 7). The following underlying pathologies were observed: ischaemic heart disease n = 120; non-ischaemic left heart disease n = 19; right heart cardiac disease n = 4; and apparently normal hearts n = 17). The average ejection fraction was 40.5 +/- 15.5% and 29 patients were in the NYHA functional classes III or IV. Fifty-five patients had life-threatening arrhythmias whilst receiving amiodarone. At 2 years, the actuarial sudden death rate was 5.9 +/- 2.1% and the actuarial total cardiac mortality rate was 13.1 +/- 2.9%. Univariate analysis showed age, the presence of underlying cardiac disease, the presence of dilated cardiomyopathy, the absence of an invasive approach, the need for basal pacing in electrical cardioversion, the absence of betablocker therapy, a decreased left ventricular ejection fraction and a high NYHA functional class, to be predictive of sudden death. In multivariate analysis, age, the NYHA class for total cardiac mortality and the NYHA class for sudden death, were the only independent predictive factors. The authors conclude that in the era of invasive methods of evaluation and widespread use of non-pharmacological therapeutic methods, the symptomatology of cardiac failure assessed by the NYHA classification remains the most powerful independent prognostic factor after an episode of malignant ventricular arrhythmia.

[Automatic implantable defibrillator and antiarrhythmic surgery in ischemic cardiopathies. Apropos of 53 cases]. / Le défibrillateur automatique implantable et la chirurgie antiarythmique dans les cardiopathies ischémiques. A propos de 53 observations.

The automatic implantable defibrillator (AID) and antiarrhythmic surgery are the two therapeutic options after failure of catheter ablation and/or antiarrhythmic therapy for sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) in patients with coronary artery disease. The authors undertook retrospective study of the characteristics of two groups of patients treated between November 31st 1987 et December 31st 1993 either by AID (28 men and 4 women with an average age of: 56.1 +/- 11.2 years) or by surgery (19 men and 2 women with an average age of: 60.6 +/- 6.8 years). The "surgical" patients differed from "defibrillator" patients in the fewer number of cardiac arrests, a higher proportion of sustained monomorphic VT, better tolerated sustained monomorphic VT (rarely syncopal), fewer early post-infarction arrythmias (< or = 8 weeks), more anterior wall infarction and a higher proportion of aneuvrysms. The perioperative mortality was 6.2% in the "defibrillator" group and nil in the "surgical" group (p = NS). At 2 years, the sudden death rate in the "defibrillator" and "surgical" groups was 7.5% and 0% respectively and total cardiac mortality was 17% and 20% respectively (p = NS). The authors conclude that perioperative mortality and the sudden death rate at 2 years are relatively low in the two groups. However, the total cardiac mortality remains high, largely related to perioperative death and secondary cardiac failure. Nevertheless, compared with defibrillator patients and with identical average ejection fractions, there was no extra mortality due to cardiac failure after antiarrhythmic surgery.