(Circulation. 1995;91:1988-1995.)
© 1995 American Heart Association, Inc.
Articles |
Significance and Incidence of Concordance of Drug Efficacy Predictions by Holter Monitoring and Electrophysiological Study in the ESVEM Trial
From the Departments of Medicine, University of Colorado Health Sciences Center, Denver (M.J.R., D.E.M.); College of Physicians and Surgeons of Columbia University, New York, NY (J.E.R.); and University of Arizona, Tucson (E.H., V.H.).
Correspondence to Michael J. Reiter, MD, PhD, Division of Cardiology, B-130, University of Colorado Health Sciences Center, 4200 E 9th Ave, Denver, CO 80262.
Background Selection of antiarrhythmic therapy may be based on either suppression of spontaneous ventricular arrhythmias assessed by Holter monitoring or by suppression of inducible ventricular arrhythmias during electrophysiological study. This study examines the frequency and significance of concordance of these two approaches in the Electrophysiologic Study Versus Electrocardiographic Monitoring (ESVEM) trial.
Methods and Results Twenty-four-hour Holter monitoring was performed in patients randomized to the electrophysiology limb of the ESVEM study at the time of the first drug trial and at the time of an effective drug trial. Holter monitors were available in 65% (146/226) of patients at the time of the first drug trial and in 93% (100/108) of patients at the time of an electrophysiology study predicting drug efficacy. There were no clinical differences between patients who had and those who did not have a Holter monitor. At the time of the first drug trial, concordance of Holter and electrophysiological predictions of drug efficacy was observed in 46% of patients (both techniques predicted efficacy in 23%; neither predicted efficacy in 23%). Discordant results were observed in 54% (Holter suppression without electrophysiological suppression in 44%; electrophysiological suppression without Holter suppression in 10%). At the time of an electrophysiology study predicting drug efficacy, 68 of the 100 patients without inducible ventricular tachyarrhythmias also had suppression of spontaneous ventricular arrhythmias on the Holter recorded at the time of the electrophysiological study. Neither arrhythmia recurrence nor mortality was significantly different in patients with suppression of both inducible and spontaneous ventricular arrhythmias compared with those with only suppression of inducible arrhythmias. Comparison of patients with suppression of both inducible and spontaneous ventricular arrhythmias with the 188 patients in the Holter limb, in whom efficacy was predicted by Holter monitoring only, revealed no difference in outcome.
Conclusions In this population, (1) there is frequent discordance in prediction of drug efficacy and inefficacy between electrophysiological study and Holter monitoring; (2) a requirement to fulfill both Holter and electrophysiological efficacy criteria reduces the number of patients with an efficacy prediction; and (3) suppression of both spontaneous ventricular ectopy and inducible ventricular tachyarrhythmias does not identify a group with better outcome.
Key Words: antiarrhythmic agents • arrhythmia • electrophysiology
This article has been cited by other articles:
 |
|
 |
|
  M. P. Anstadt and J. E. Lowe Cardiopulmonary Resuscitation Card. Surg. Adult, January 1, 2003; 2(2003): 471 - 494. [Full Text]
|
|
|
|
 |
|
 S Brili, C Aggeli, K Gatzoulis, A Tzonou, C Hatzos, C Pitsavos, C Stefanadis, and P Toutouzas Echocardiographic and signal averaged ECG indices associated with non-sustained ventricular tachycardia after repair of tetralogy of Fallot Heart, January 1, 2001; 85(1): 57 - 60. [Abstract] [Full Text]
|
|
|
|
 |
|
 F. E. Marchlinski Predicting Arrhythmic Death : A Plea for Standardized Reporting Techniques and Data Based on Continuous Electrocardiographic Monitoring Circulation, September 16, 1997; 96(6): 1713 - 1716. [Full Text]
|
|
|
|
|
|
L. S. Gettes ESVEM and the Hazards of Clinical Trials Circulation, April 1, 1995; 91(7): 1908 - 1909. [Full Text]
|
|