Fuenmayor AJ et al. (2004) Bedside programmed ventricular stimulation for sudden death risk stratification. Int J Cardiol 97: 69–72

Programmed ventricular stimulation is used to identify patients at high risk of sudden death following myocardial infarction. This procedure is costly in terms of personnel and equipment, however, and is not routinely available in Third World countries. A recent study from Venezuela describes a bedside ventricular stimulation protocol for cardiac risk stratification.

Authors Fuenmayor et al. studied 412 patients with acute myocardial infarction. A subset of 50 patients had a low left-ventricular ejection fraction (<40%) and ventricular arrhythmia, late potentials or low heart-rate variability. These patients were considered to be at high risk of sudden death and were subjected to the ventricular stimulation protocol. Under fluoroscopy guidance and electrocardiographic monitoring, a central venous access was placed and a quadripolar catheter was advanced to the right-ventricular apex. Using a portable stimulator, programmed ventricular stimulation was then performed, with up to three extrastimuli.

No complications were attributable to the procedure. Reproducible ventricular tachycardia or ventricular fibrillation was induced in six patients. These patients received amiodarone and an automatic implantable cardioverter defibrillator was subsequently placed in five cases. During a mean follow-up of 22 ± 6 months, all five patients received appropriate discharges from the device. All 50 high-risk patients were alive at the end of the study.

The authors conclude that bedside programmed stimulation was safe and effective in this study. Since the procedure is cheaper and more convenient than conventional methods, they suggest that it deserves further investigation as an alternative means of risk stratification in patients with myocardial infarction.