Prognostic significance of nonsustained ventricular tachycardia after revascularization

Suneet Mittal, David J. Lomnitz, Sunil Mirchandani, Kenneth M. Stein, Steven M. Markowitz, David J. Slotwiner, Sei Iwai, Mithilesh Das, Bruce B. Lerman

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Introduction: Two randomized trials (Multicenter Automatic Defibrillator Implantation Trial [MADIT] and Multicenter Unsustained Tachycardia Trial [MUSTT]) suggest that implantable cardioverter defibrillator (ICD) placement is associated with improved survival in patients with coronary artery disease, depressed left ventricular function, and nonsustained ventricular tachycardia (VT) who also have inducible sustained VT. However, neither study directly addresses the management of such patients who develop nonsustained VT early after revascularization. Methods and Results: We evaluated 109 consecutive patients who underwent electrophysiologic testing to evaluate nonsustained VT, which occurred 5 ± 4 days following revascularization. Sustained monomorphic VT was inducible in 46 (42%) patients; these patients received an ICD. The remaining 63 (58%) noninducible patients received neither antiarrhythmic drug therapy nor an ICD. During 27 ± 12 months of follow-up, 15 (33%) of 45 patients with an implanted ICD received at least one appropriate therapy from the device and 26 (24%) of the 109 study patients died. The 1- and 2-year freedom from ventricular tachycardia/fibrillation or sudden death in noninducible patients (97% and 93%) was significantly greater than that of inducible patients (84% and 71%; P = 0.001). However, no difference was observed in total mortality. Conclusion: Patients with nonsustained VT during the early postrevascularization period who have inducible VT have a high incidence of arrhythmic events. Although this study was not designed to assess the impact of ICD placement on the total mortality of inducible patients, the finding that one third of these patients received appropriate ICD therapy suggests that the device may have a protective effect in these patients.

Original languageEnglish (US)
Pages (from-to)342-346
Number of pages5
JournalJournal of Cardiovascular Electrophysiology
Volume13
Issue number4
StatePublished - 2002
Externally publishedYes

Fingerprint

Ventricular Tachycardia
Implantable Defibrillators
Multicenter Studies
Equipment and Supplies
Defibrillators
Mortality
Anti-Arrhythmia Agents
Ventricular Fibrillation
Sudden Death
Left Ventricular Function
Tachycardia
Coronary Artery Disease

Keywords

  • Prognosis
  • Revascularization
  • Tachyarrhythmias

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

Cite this

Mittal, S., Lomnitz, D. J., Mirchandani, S., Stein, K. M., Markowitz, S. M., Slotwiner, D. J., ... Lerman, B. B. (2002). Prognostic significance of nonsustained ventricular tachycardia after revascularization. Journal of Cardiovascular Electrophysiology, 13(4), 342-346.

Prognostic significance of nonsustained ventricular tachycardia after revascularization. / Mittal, Suneet; Lomnitz, David J.; Mirchandani, Sunil; Stein, Kenneth M.; Markowitz, Steven M.; Slotwiner, David J.; Iwai, Sei; Das, Mithilesh; Lerman, Bruce B.

In: Journal of Cardiovascular Electrophysiology, Vol. 13, No. 4, 2002, p. 342-346.

Research output: Contribution to journalArticle

Mittal, S, Lomnitz, DJ, Mirchandani, S, Stein, KM, Markowitz, SM, Slotwiner, DJ, Iwai, S, Das, M & Lerman, BB 2002, 'Prognostic significance of nonsustained ventricular tachycardia after revascularization', Journal of Cardiovascular Electrophysiology, vol. 13, no. 4, pp. 342-346.
Mittal S, Lomnitz DJ, Mirchandani S, Stein KM, Markowitz SM, Slotwiner DJ et al. Prognostic significance of nonsustained ventricular tachycardia after revascularization. Journal of Cardiovascular Electrophysiology. 2002;13(4):342-346.
Mittal, Suneet ; Lomnitz, David J. ; Mirchandani, Sunil ; Stein, Kenneth M. ; Markowitz, Steven M. ; Slotwiner, David J. ; Iwai, Sei ; Das, Mithilesh ; Lerman, Bruce B. / Prognostic significance of nonsustained ventricular tachycardia after revascularization. In: Journal of Cardiovascular Electrophysiology. 2002 ; Vol. 13, No. 4. pp. 342-346.
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abstract = "Introduction: Two randomized trials (Multicenter Automatic Defibrillator Implantation Trial [MADIT] and Multicenter Unsustained Tachycardia Trial [MUSTT]) suggest that implantable cardioverter defibrillator (ICD) placement is associated with improved survival in patients with coronary artery disease, depressed left ventricular function, and nonsustained ventricular tachycardia (VT) who also have inducible sustained VT. However, neither study directly addresses the management of such patients who develop nonsustained VT early after revascularization. Methods and Results: We evaluated 109 consecutive patients who underwent electrophysiologic testing to evaluate nonsustained VT, which occurred 5 ± 4 days following revascularization. Sustained monomorphic VT was inducible in 46 (42{\%}) patients; these patients received an ICD. The remaining 63 (58{\%}) noninducible patients received neither antiarrhythmic drug therapy nor an ICD. During 27 ± 12 months of follow-up, 15 (33{\%}) of 45 patients with an implanted ICD received at least one appropriate therapy from the device and 26 (24{\%}) of the 109 study patients died. The 1- and 2-year freedom from ventricular tachycardia/fibrillation or sudden death in noninducible patients (97{\%} and 93{\%}) was significantly greater than that of inducible patients (84{\%} and 71{\%}; P = 0.001). However, no difference was observed in total mortality. Conclusion: Patients with nonsustained VT during the early postrevascularization period who have inducible VT have a high incidence of arrhythmic events. Although this study was not designed to assess the impact of ICD placement on the total mortality of inducible patients, the finding that one third of these patients received appropriate ICD therapy suggests that the device may have a protective effect in these patients.",
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AU - Lomnitz, David J.

AU - Mirchandani, Sunil

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AU - Markowitz, Steven M.

AU - Slotwiner, David J.

AU - Iwai, Sei

AU - Das, Mithilesh

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