Duration of Inducible Ventricular Tachycardia Early After ST‐Segment–Elevation Myocardial Infarction and Its Impact on Mortality and Ventricular Tachycardia Recurrence
Background The clinical significance of the duration of inducible ventricular tachycardia (VT) at electrophysiology study (EPS) in patients soon after ST‐segment–elevation myocardial infarction and its predictive utility for VT recurrence are not known. Methods and Results Consecutive ST‐segment–ele...
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| Format: | Article |
| Language: | English |
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Wiley
2020-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.015204 |
| _version_ | 1819175004895444992 |
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| author | Tejas Deshmukh Sarah Zaman Arun Narayan Pramesh Kovoor |
| author_facet | Tejas Deshmukh Sarah Zaman Arun Narayan Pramesh Kovoor |
| author_sort | Tejas Deshmukh |
| collection | DOAJ |
| description | Background The clinical significance of the duration of inducible ventricular tachycardia (VT) at electrophysiology study (EPS) in patients soon after ST‐segment–elevation myocardial infarction and its predictive utility for VT recurrence are not known. Methods and Results Consecutive ST‐segment–elevation myocardial infarction patients with day 3 to 5 left ventricular ejection fraction ≤40% underwent EPS. A positive EPS was defined as sustained monomorphic VT with cycle length ≥200 ms. The induced VT was terminated by overdrive pacing or direct current shock at 30 s or earlier if hemodynamic decompensation occurred. Patients with inducible VT duration 2 to 10 s were compared with patients with inducible VT >10 s. The primary end point was survival free of VT or cardiac mortality. From 384 consecutive ST‐segment–elevation myocardial infarction patients who underwent EPS, 29% had inducible VT (n=112, 87% men). After mean follow‐up of 5.9±3.9 years, primary end point occurred in 35% of patients with induced VT 2 to 10 s duration (n=68) and in 22% of patients with induced VT >10 s (n=41) (P=0.61). This was significantly different from the noninducible VT group, in which primary end point occurred in 3% of patients (n=272) (P=0.001). Conclusions This study is the first to show that in patients who undergo EPS early after myocardial infarction, inducible VT of short duration (2–10 s) has similar predictive utility for ventricular tachyarrhythmia as longer duration (>10 s) inducible VT, which was significantly different to those without inducible VT. It is possible that immediate cardioversion of rapid VT might have contributed to some of the short durations of inducible VT. |
| first_indexed | 2024-12-22T20:47:59Z |
| format | Article |
| id | doaj.art-197535c9c1354dc58c262c2e43cd6c53 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T20:47:59Z |
| publishDate | 2020-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-197535c9c1354dc58c262c2e43cd6c532022-12-21T18:13:09ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802020-07-0191310.1161/JAHA.119.015204Duration of Inducible Ventricular Tachycardia Early After ST‐Segment–Elevation Myocardial Infarction and Its Impact on Mortality and Ventricular Tachycardia RecurrenceTejas Deshmukh0Sarah Zaman1Arun Narayan2Pramesh Kovoor3Department of Cardiology Westmead Hospital Sydney AustraliaMonash University Melbourne AustraliaDepartment of Cardiology Westmead Hospital Sydney AustraliaDepartment of Cardiology Westmead Hospital Sydney AustraliaBackground The clinical significance of the duration of inducible ventricular tachycardia (VT) at electrophysiology study (EPS) in patients soon after ST‐segment–elevation myocardial infarction and its predictive utility for VT recurrence are not known. Methods and Results Consecutive ST‐segment–elevation myocardial infarction patients with day 3 to 5 left ventricular ejection fraction ≤40% underwent EPS. A positive EPS was defined as sustained monomorphic VT with cycle length ≥200 ms. The induced VT was terminated by overdrive pacing or direct current shock at 30 s or earlier if hemodynamic decompensation occurred. Patients with inducible VT duration 2 to 10 s were compared with patients with inducible VT >10 s. The primary end point was survival free of VT or cardiac mortality. From 384 consecutive ST‐segment–elevation myocardial infarction patients who underwent EPS, 29% had inducible VT (n=112, 87% men). After mean follow‐up of 5.9±3.9 years, primary end point occurred in 35% of patients with induced VT 2 to 10 s duration (n=68) and in 22% of patients with induced VT >10 s (n=41) (P=0.61). This was significantly different from the noninducible VT group, in which primary end point occurred in 3% of patients (n=272) (P=0.001). Conclusions This study is the first to show that in patients who undergo EPS early after myocardial infarction, inducible VT of short duration (2–10 s) has similar predictive utility for ventricular tachyarrhythmia as longer duration (>10 s) inducible VT, which was significantly different to those without inducible VT. It is possible that immediate cardioversion of rapid VT might have contributed to some of the short durations of inducible VT.https://www.ahajournals.org/doi/10.1161/JAHA.119.015204electrophysiology studymyocardial infarctionventricular tachycardia |
| spellingShingle | Tejas Deshmukh Sarah Zaman Arun Narayan Pramesh Kovoor Duration of Inducible Ventricular Tachycardia Early After ST‐Segment–Elevation Myocardial Infarction and Its Impact on Mortality and Ventricular Tachycardia Recurrence Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease electrophysiology study myocardial infarction ventricular tachycardia |
| title | Duration of Inducible Ventricular Tachycardia Early After ST‐Segment–Elevation Myocardial Infarction and Its Impact on Mortality and Ventricular Tachycardia Recurrence |
| title_full | Duration of Inducible Ventricular Tachycardia Early After ST‐Segment–Elevation Myocardial Infarction and Its Impact on Mortality and Ventricular Tachycardia Recurrence |
| title_fullStr | Duration of Inducible Ventricular Tachycardia Early After ST‐Segment–Elevation Myocardial Infarction and Its Impact on Mortality and Ventricular Tachycardia Recurrence |
| title_full_unstemmed | Duration of Inducible Ventricular Tachycardia Early After ST‐Segment–Elevation Myocardial Infarction and Its Impact on Mortality and Ventricular Tachycardia Recurrence |
| title_short | Duration of Inducible Ventricular Tachycardia Early After ST‐Segment–Elevation Myocardial Infarction and Its Impact on Mortality and Ventricular Tachycardia Recurrence |
| title_sort | duration of inducible ventricular tachycardia early after st segment elevation myocardial infarction and its impact on mortality and ventricular tachycardia recurrence |
| topic | electrophysiology study myocardial infarction ventricular tachycardia |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.015204 |
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