Key result
Inducible very fast VT early after STEMI was associated with a 33.1% 4-year incidence of death or arrhythmia, similar to standard VT (37.0%) and higher than negative EPS (8.2%; P<0.001).
Why the study?
Does inducible very fast ventricular tachycardia (cycle length 200-230 ms) predict death or arrhythmic events in patients with STEMI and LVEF ≤40% after primary PCI?
Cohort (n=290)
Does inducible very fast ventricular tachycardia (cycle length 200-230 ms) predict death or arrhythmic events in patients with STEMI and LVEF ≤40% after primary PCI?
Absolute Event Rate: 33.1% vs 8.2%
p-value: p=<0.001
Inducible very fast VT (cycle length 200-230 ms) early after reperfused STEMI carries a similar risk of death or arrhythmia as standard VT, and both indicate a significantly higher risk than a negative EPS.
Inducible very fast VT early after STEMI reperfusion remains of uncertain significance; leaves open its role in sudden death risk stratification.
BACKGROUND: Electrophysiological study (EPS) after myocardial infarction may have a role in identifying patients at risk of sudden cardiac death. It has been shown previously that inducible very fast ventricular tachycardia (VT; cycle length [CL], 200-230 ms) is predictive of arrhythmia recurrence; however, its significance early after reperfusion in ST-segment-elevation myocardial infarction is unknown. METHODS AND RESULTS: Consecutive patients with ST-segment-elevation myocardial infarction treated with primary percutaneous coronary intervention with a left ventricular ejection fraction ≤40% underwent early EPS with an implantable-cardioverter defibrillator implanted for inducible VT, but not for a negative EPS. The end point was the cumulative incidence of death or first arrhythmic event (defined as resuscitated cardiac arrest or spontaneous ventricular tachyarrhythmia). A total of 1721 patients with ST-segment-elevation myocardial infarction underwent early left ventricular ejection fraction assessment (median, 4 days after myocardial infarction) with a left ventricular ejection fraction≤40% in 24%. EPS was performed in 290 eligible patients with no arrhythmia or ventricular fibrillation/flutter (CL<200 ms) induced in 203 patients (EPS negative, group 1), monomorphic VT induced in 87 patients, consisting of very fast VT in 67% (group 2; n=58), and standard VT (CL>230 ms) in 33% (group 3; n=29). Kaplan-Meier 4-year cumulative incidence of death or arrhythmia was 8.2±2.3%, 33.1±7.1%, and 37.0±10.2% in groups 1, 2, and 3, respectively (P<0.001). CONCLUSIONS: The majority of inducible VT in patients who have been reperfused early after ST-segment-elevation myocardial infarction is very fast VT (CL, 200-230 ms). This very fast VT incurs at least a similar risk of arrhythmia or death as inducible standard VT (CL>230 ms) and a significantly higher risk than patients with a negative EPS.
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Zaman et al. (2013) conducted a cohort in ST-segment-elevation myocardial infarction (n=290). Inducible very fast ventricular tachycardia (cycle length 200-230 ms) vs. Negative EPS or standard VT was evaluated on Cumulative incidence of death or first arrhythmic event (resuscitated cardiac arrest or spontaneous ventricular tachyarrhythmia) (p=<0.001). Inducible very fast VT early after STEMI was associated with a 33.1% 4-year incidence of death or arrhythmia, similar to standard VT (37.0%) and higher than negative EPS (8.2%; P<0.001).
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