Value of programmed ventricular stimulation in the evaluation and management of patients with nonsustained ventricular tachycardia associated with coronary artery disease.

Programmed ventricular stimulation with up to 3 extrastimuli at the right ventricular apex was performed in 52 patients with spontaneous nonsustained ventricular tachycardia (VT) associated with coronary artery disease. There were 44 men and 8 women, aged 66 +/- 9 years (range 45 to 86). The mean left ventricular ejection fraction was 41 +/- 14%. Nonsustained VT was asymptomatic in 10 patients (19%), while the arrhythmia was detected during evaluation of palpitations in 5 patients (10%), presyncope in 11 (21%) and syncope in 26 patients (50%). All patients were tested in the drug-free state and were classified as having no inducible arrhythmia (31 patients, group I), or an inducible arrhythmia (21 patients, group II). The age, gender, type of heart disease, symptoms and left ventricular ejection fraction were similar in both groups. Group I patients had a higher overall incidence of syncope. Group I patients received no therapy, while group II patients received antiarrhythmic therapy guided by electropharmacologic testing. At 21 +/- 17 months there was no sustained VT in either group. There were 3 deaths in group I patients, including 1 sudden, 1 nonsudden cardiac and 1 noncardiac death. In group II patients 6 deaths occurred including 4 nonsudden cardiac and 2 noncardiac deaths. In patients with nonsustained VT and coronary artery disease undergoing programmed ventricular stimulation, the incidence of significant arrhythmic events is low in those without therapy with no inducible arrhythmia, and in those with an inducible arrhythmia with therapy guided by electrophysiologic testing.