Electrophysiologic testing induced sustained monomorphic ventricular tachycardia in only 9.5% of survivors of documented ventricular fibrillation, compared to 90% of patients with documented VT.
Observational (n=101)
Does electrophysiologic testing reliably induce sustained monomorphic VT in patients resuscitated from documented ventricular fibrillation compared to those with documented VT?
Electrophysiologic testing rarely induces sustained monomorphic VT in survivors of documented VF, suggesting it may be more cost-effective to proceed directly to ICD implantation.
Absolute Event Rate: 9.5% vs 90%
INTRODUCTION: Electrophysiologic testing is performed in patients resuscitated from ventricular fibrillation (VF) on the assumption that sustained monomorphic ventricular tachycardia (VT) may be a precursor to VF, with the former amenable to assessment by serial drug testing. METHODS AND RESULTS: We assessed the usefulness of this strategy by analyzing clinical and electrophysiologic data of 42 survivors (29 men and 13 women; mean age 54 +/- 14 years) of VF without a reversible cause. All patients had VF documented on ECG and required defibrillation. Underlying heart diseases included coronary disease in 28, dilated cardiomyopathy in 3, arrhythmogenic right ventricular dysplasia in 1, and no apparent structural heart disease in 10 patients. Only 2 (4.7%) patients had a prior history of documented VT. The electrophysiologic study was performed 7 to 30 days after VF. Programmed stimulation at the right ventricular apex using at least two drive cycle lengths and up to three extrastimuli induced sustained monomorphic VT in 4 (9.5%), sustained polymorphic VT in 3 (7.1%), nonsustained monomorphic VT in 1 (2.3%), nonsustained polymorphic VT in 5 (11.9%), and VF in 13 (30.9%) patients. Two patients with documented prior VT and coronary disease had sustained VT induced during the electrophysiologic study. On the other hand, sustained monomorphic VT was induced in 53 of the 59 (90%) patients (45 men and 14 women; mean age 57 +/- 16 years) with clinically documented VT concurrently studied using the same stimulation protocol. CONCLUSION: We conclude that reproducible induction of sustained monomorphic VT in survivors of documented VF is uncommon. It may be more cost effective to proceed directly to treatment with implantable cardioverter defibrillators in these patients.
LI et al. (Sat,) conducted a observational in Resuscitated from documented ventricular fibrillation (n=101). Electrophysiologic testing vs. Patients with clinically documented VT was evaluated on Induction of sustained monomorphic ventricular tachycardia. Electrophysiologic testing induced sustained monomorphic ventricular tachycardia in only 9.5% of survivors of documented ventricular fibrillation, compared to 90% of patients with documented VT.