TY - JOUR
T1 - Significance of inducible very fast ventricular tachycardia (cycle length 200-230 ms) after early reperfusion for ST-segment-elevation myocardial infarction
AU - Zaman, Sarah
AU - Kumar, Saurabh
AU - Sullivan, Janice
AU - Narayan, Arun
AU - Thiagalingam, Aravinda
AU - Ross, David L.
AU - Kovoor, Pramesh
PY - 2013/10
Y1 - 2013/10
N2 - 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/futter (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.
AB - 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/futter (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.
KW - Arrhythmias, cardiac
KW - Cardioverter-defibrillators, implantable
KW - Death, sudden, cardiac
KW - Electrophysiology
KW - Myocardial infarction
KW - Tachycardia, ventricular
UR - http://www.scopus.com/inward/record.url?scp=84891553791&partnerID=8YFLogxK
U2 - 10.1161/CIRCEP.113.000213
DO - 10.1161/CIRCEP.113.000213
M3 - Article
C2 - 23995117
AN - SCOPUS:84891553791
SN - 1941-3149
VL - 6
SP - 884
EP - 890
JO - Circulation: Arrhythmia and Electrophysiology
JF - Circulation: Arrhythmia and Electrophysiology
IS - 5
ER -