The prognosis of 149 patients with ventricular tachycardia (n = 108) or ventricular fibrillation (n = 41) was analyzed to assess the importance or the underlying etiology of the arrhythmia. Seventy-three patients (Group I) had a previous myocardial infarction and documented late sustained monomorphic ventricular tachycardia. Thirty-five (Group II) also had a previous myocardial infarction but had late ventricular fibrillation. There were 41 patients (Group III) without coronary artery disease: 9 patients with right ventricular dysplasia, 26 with idiopathic sustained ventricular tachycardia and 6 with idiopathic ventricular fibrillation. The mean follow-up period for all patients was 22 to 57 months. The total mortality rate in Group I (16%) and Group II (34%) and the arrhythmic mortality rate in Group I (5%) and Group II (11%) were significantly higher than the rates in Group III. In the latter group the total mortality rate was 4% for those with idiopathic ventricular tachycardia and 11% for those with right ventricular dysplasia, and there were no deaths due to arrhythmia (p <0.05). Left ventricular ejection fraction was significantly lower and left ventricular end-diastolic pressure was significantly higher in Group I and Group II than in Group III. There were nonfatal recurrences of ventricular tachycardia in 33 to 56% of patients, and the number of these episodes did not differ significantly in those with and without coronary artery disease. In summary, although the incidence of recurrence of nonfatal ventricular tachycardia is similar in patients with and without coronary artery disease, total and arrhythmic mortality is significantly higher in patients with coronary artery disease and is related to the degree of left ventricular dysfunction. The prognosis of patients with right ventricular dysplasia, idiopathic ventricular tachycardia or ventricular fibrillation is excellent when these patients are treated medically.
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