Nonsustained ventricular tachycardia during programmed ventricular stimulation: criteria for a positive test.

Controversy persists among groups carrying out programmed ventricular stimulation (PVS) as to which criteria should be used to define a positive test. To examine this question, the results of PVS carried out in 50 patients with documented sustained ventricular tachycardia (VT) or ventricular fibrillation were retrospectively analyzed. All patients underwent serial PVS using single and double extrastimuli and ventricular burst pacing in the right ventricle and, when necessary, the left ventricle, with sustained VT elicited during the control study in each patient. Antiarrhythmic drugs were then administered, with therapy tailored to both PVS result and ambulatory Holter monitoring, when possible. All patients were maintained and followed on the same drugs and dosages as at the time of predischarge PVS. After mean 20 months follow-up, 28 patients either died suddenly (8 patients) or had documented sustained VT (20 patients). The ability to induce nonsustained or sustained VT on predischarge PVS was associated with a significantly higher likelihood of subsequent sudden death or VT recurrence than if VT could not be induced (p less than 0.001). In addition, using the criterion of 5 or more beats of induced VT to define a positive study maximized the predictive value of PVS and provided a significantly higher predictive accuracy than if only sustained VT were used to define a positive study.(ABSTRACT TRUNCATED AT 250 WORDS)