Value of programmed ventricular stimulation in patients with congenital heart disease

J Cardiovasc Electrophysiol. 1999 Aug;10(8):1033-44. doi: 10.1111/j.1540-8167.1999.tb00274.x.


Introduction: The role of programmed ventricular stimulation (VSTIM) for risk stratification in congenital heart disease is unclear. We analyzed the results of VSTIM in selected congenital heart disease survivors at a single center to determine whether it improved the ability to predict a serious outcome.

Methods and results: Between July 1985 and September 1996, 140 primary VSTIM studies were performed on 130 patients (median age 18.1 years, range 0 to 51). Tetralogy of Fallot (33 %), d-transposition of the great arteries (25 %), and left ventricular outflow tract obstruction (12%) accounted for the majority of patients. Indications included spontaneous ventricular tachycardia (VT) of > or = 3 beats (72%) and/or symptoms (68%). Sustained VT was induced in 25% of the studies, and nonsustained VT in 12%. Atrial flutter or other supraventricular tachycardia was documented in 32% and bradyarrhythmias in 26%. By univariate analysis, mortality was increased in patients with positive VSTIM versus negative VSTIM (18% vs 7%, P = 0.04). Using multivariate analysis, positive VSTIM was associated with a sixfold increased risk of decreased survival and a threefold increased risk of serious arrhythmic events, allowing up to 87% sensitivity in predicting mortality. However, 7 (33%) of 21 patients with documented clinical VT had false-negative studies.

Conclusion: VSTIM in a large, selected group of congenital heart disease patients identified a subgroup with significantly increased mortality and sudden arrhythmic events. Failure to induce VT was a favorable prognostic sign, but the frequency of false-negative studies was high. Frequent supraventricular tachycardia further complicated risk stratification. Although VSTIM appears to be a reasonable tool for evaluation of this population, a larger, multicenter trial is recommended to clarify its utility.

Publication types

  • Clinical Trial
  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Death, Sudden, Cardiac / prevention & control
  • Electric Stimulation
  • Electrocardiography, Ambulatory
  • Female
  • Heart Block / diagnosis*
  • Heart Block / etiology
  • Heart Block / mortality
  • Heart Defects, Congenital / complications
  • Heart Defects, Congenital / mortality
  • Heart Defects, Congenital / physiopathology*
  • Heart Ventricles / physiopathology*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Retrospective Studies
  • Risk Factors
  • Survival Rate
  • Tachycardia, Supraventricular / diagnosis*
  • Tachycardia, Supraventricular / etiology
  • Tachycardia, Supraventricular / mortality
  • Tachycardia, Ventricular / diagnosis*
  • Tachycardia, Ventricular / etiology
  • Tachycardia, Ventricular / mortality