TY - JOUR
T1 - Refractory symptomatic ventricular tachycardia and ventricular fibrillation in elderly patients
AU - Tresch, Donald D.
AU - Platia, Edward V.
AU - Guarnieri, Thomas
AU - Reid, Philip R.
AU - Griffith, Lawrence S.C.
N1 - Funding Information:
From the Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, Maryland. This work was supported in part by the Hartford Foundation and was performed when Dr. Tresch was a Hartford Geriatrics Scholar at Johns Hopkins Medical School. Manuscript submitted January 5, 1987, and accepted April 14, 1987. l Current address and address for reprint requests: Cardiology Division, Medical College of Wisconsin, 8700 West Wisconsin Avenue: Milwaukee, Wisconsin 53226.
PY - 1987/9
Y1 - 1987/9
N2 - The problem of refractory life-threatening ventricular tachyarrhythmias in elderly patients has not been previously studied. To determine if clinical, anatomic, or electrophysiologic variables and prognosis are significantly different in elderly subjects, 49 elderly (68 to 84 years) and 44 younger (44 to 53 years) survivors of refractory symptomatic ventricular tachycardia and/or ventricular fibrillation secondary to coronary artery disease were studied. Elderly patients displayed more extensive anatomic coronary artery disease, with 80 percent having three-vessel disease in comparison with 30 percent of the younger patients (p <0.001). Prior myocardial infarction, heart failure, and cardiomegaly were more common in the elderly group (p <0.01, p <0.001, and p <0.034, respectively), whereas angina was more common in the younger group (p <0.001). In 55 percent of the elderly patients and 58 percent of the younger patients, electrophysiologic testing demonstrated inducible sustained ventricular tachycardia that required treatment with an investigative antiarrhythmic drug and/or cardiac surgery, including implantation of an automatic defibrillator. Elderly patients tolerated aggressive evaluation as well as did younger patients, and despite the difference in clinical and anatomic findings, long-term survival curves were similar, although the probability of survival at 20 months was 62 percent in the elderly and 80 percent in the younger patients. This difference in early survival is explained by eight surgical deaths in the elderly group, compared with two in the younger group.
AB - The problem of refractory life-threatening ventricular tachyarrhythmias in elderly patients has not been previously studied. To determine if clinical, anatomic, or electrophysiologic variables and prognosis are significantly different in elderly subjects, 49 elderly (68 to 84 years) and 44 younger (44 to 53 years) survivors of refractory symptomatic ventricular tachycardia and/or ventricular fibrillation secondary to coronary artery disease were studied. Elderly patients displayed more extensive anatomic coronary artery disease, with 80 percent having three-vessel disease in comparison with 30 percent of the younger patients (p <0.001). Prior myocardial infarction, heart failure, and cardiomegaly were more common in the elderly group (p <0.01, p <0.001, and p <0.034, respectively), whereas angina was more common in the younger group (p <0.001). In 55 percent of the elderly patients and 58 percent of the younger patients, electrophysiologic testing demonstrated inducible sustained ventricular tachycardia that required treatment with an investigative antiarrhythmic drug and/or cardiac surgery, including implantation of an automatic defibrillator. Elderly patients tolerated aggressive evaluation as well as did younger patients, and despite the difference in clinical and anatomic findings, long-term survival curves were similar, although the probability of survival at 20 months was 62 percent in the elderly and 80 percent in the younger patients. This difference in early survival is explained by eight surgical deaths in the elderly group, compared with two in the younger group.
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U2 - 10.1016/0002-9343(87)90747-9
DO - 10.1016/0002-9343(87)90747-9
M3 - Article
C2 - 3661580
AN - SCOPUS:0023634355
SN - 0002-9343
VL - 83
SP - 399
EP - 404
JO - The American journal of medicine
JF - The American journal of medicine
IS - 3
ER -