title: Influence of ventricular function and presence or absence of coronary artery disease on results of electrophysiologic testing for asymptomatic nonsustained ventricular tachycardia.
abstract: One hundred ten patients with asymptomatic nonsustained ventricular tachycardia (VT) were evaluated prospectively to assess the value of electrophysiologic testing. This testing consisted of up to 3 extrastimuli delivered during 3 drive cycle lengths from 2 right ventricular sites. A positive study was defined as monomorphic VT lasting 30 seconds or requiring cardioversion. Patients with a positive study were treated, and serial drug testing was done. An event during follow-up was sustained VT or cardiac arrest. The mean follow-up was 15 months. Of 57 patients with an ejection fraction greater than or equal to 40%, 6 had a positive electrophysiologic test with 1 event and 51 had a negative test with 1 event. Twenty-eight patients had an ejection fraction less than 40% and coronary artery disease: 14 had a positive test with 1 event, and 14 had a negative test with 3 events. Twenty-five patients had an ejection fraction less than 40% and no coronary artery disease: 1 had a positive test with no events, and 24 had a negative test with 8 events. Only ejection fraction and congestive heart failure class were found to be independent predictors of outcome. Patients with an ejection fraction greater than 40% had low inducibility (11%), had few events (3.5%) and did not require electrophysiologic testing. In patients with an ejection fraction less than 40% and coronary artery disease, inducibility was high (50%) and a negative study was of no value. Patients with an ejection fraction less than 40% and no coronary artery disease had low inducibility (4%), had frequent events (33%) and did not benefit from electrophysiologic testing.
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester 55905.
authors.forename: S C
authors.initials: SC
authors.lastname: Hammill
authors.forename: J M
authors.initials: JM
authors.lastname: Trusty
authors.forename: D L
authors.initials: DL
authors.lastname: Wood
authors.forename: K R
authors.initials: KR
authors.lastname: Bailey
authors.forename: P J
authors.initials: PJ
authors.lastname: Vatterott
authors.forename: M J
authors.initials: MJ
authors.lastname: Osborn
authors.forename: D R
authors.initials: DR
authors.lastname: Holmes
authors.forename: B J
authors.initials: BJ
authors.lastname: Gersh
mesh_terms: D000328:Adult; D000368:Aged; D002304:Cardiac Pacing, Artificial; D003327:Coronary Disease / Q000150:complications*; D004594:Electrophysiology; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology*; D013610:Tachycardia / Q000175:diagnosis* / Q000401:mortality; D013997:Time Factors