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Between 1985 and 1997, 86 patients with spontaneous
documented MSVT were observed in our institution. The diagnosis of VT was based on
spontaneous or provoked VA dissociation on surface ECG or MB mode echocardiography or
endocavitary electrogram. A study analyzed the time of survival after the first clinical
episode of MSVT. Sudden death was defined as death occuring less than 1 hour after the
onset of symptoms or, when expected, death occurring during the sleep. The mean follow-up
duration of our patients population was 40.04 ± 47.26 months (mean ± SD).
The patients were divided into 3 groups according to the aetiology:
Group I: 29 patients, 27 males and 2 females, aged 67.48 ± 9.31 years with old
myocardial infarction (> 4 weeks) (34%);
Group II: 38 patients, 34 males and 4 females, aged 65.56 ± 13.9 years with acute
myocardial infarction (44%);
Group III: 19 patients, 13 males and 6 females, aged 53.63 ± 21.19 years with a non
ischemic heart disease (22%) (11 with an idiopathic dilated cardiomyopathy - DCM -, 2 with
a right cardiomyopathy, 2 with a congenital heart disease, 2 with a rheumatic heart
disease, 2 with a hypertensive heart disease).
The QRS configuration during tachycardia was defined as an RBBB shape, as an LBBB
shape and as a positive or negative precordial concordant pattern if the QRS morphology
was completely positive or negative in all precordial leads.
The clinical presentation of MSVT was considered as haemodynamically stable or
unstable. As haemodynamically stable was considered the tachycardia without syncope or
pre-syncope, acute pulmonary oedema, low cardiac output, angina and systolic BP > 100
mmHg. As haemodynamically unstable was considered the tachycardia in presence of syncope,
pre-syncope, acute polmonary oedema, low cardiac output, angina, observed separately or
associated with one another.
The pharmacological treatment was mostly chosen empirically. Since the beginning of
the 90's it has been usually carried on through the electropharmacological study.
The treatment efficacy was judged clinically. It was qualified as inefficient if a
recurrence was documented at any time during the follow-up. Firstly, IC class
antiarrhythmic drugs, mostly propafenone, were used. Later, after the results of CAST, and
due to the increasingly higher evidence of the preventive action of beta-blockers in SD,
mostly sotalol or amiodarone were used. The last one usually was the drug of choice on
patients with LVEF < 0.4.
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