To study prognostic factors in patients with sustained
ventricular tachycardias (VT) or
ventricular fibrillation (VF) complicated by
left ventricular dysfunction, we evaluated the predictive value of demographic, clinical, and hemodynamic parameters for cardiac mortality and
sudden cardiac death in 85 patients with VT or VF and left ventricular ejection fraction < 0.45 (mean 0.27 +/- 0.10). Patients underwent serial
drug testing and received appropriate antiarrhythmic treatment, with
amiodarone given as last-resort
therapy. During a follow-up of 24 +/- 13 months, 23 patients died of cardiac causes, and 18 of them died suddenly. Left ventricular ejection fraction < or = 0.27 and
amiodarone treatment were related to greater cardiac mortality and increased risk of
sudden cardiac death, whereas beta-blockade was associated with improved survival. In the multivariate model cardiac mortality was best predicted by a left ventricular ejection fraction < or = 0.27, and absence of beta-blockade and severe
left ventricular dysfunction were the strongest predictors of
sudden cardiac death. We conclude that severe
left ventricular dysfunction predicts increased cardiac mortality and high risk of
sudden cardiac death. Moreover, beta-blocking treatment is associated with lower cardiac mortality and a reduced risk of
sudden cardiac death in patients with sustained VT or VF and depressed left ventricular function. beta-Blocking agents may therefore be an important addition to conventional antiarrhythmic treatment in patients with VT or VF and
left ventricular dysfunction.