Prognostic significance of nonsustained ventricular tachycardia after revascularization.
BACKGROUND
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.


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.


CONCLUSIONS
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.
Mittal
Suneet
S
Department of Medicine, The New York Hospital-Cornell Medical Center, New York 10021, USA.
Lomnitz
David J
DJ
Mirchandani
Sunil
S
Stein
Kenneth M
KM
Markowitz
Steven M
SM
Slotwiner
David J
DJ
Iwai
Sei
S
Das
Mithilesh K
MK
Lerman
Bruce B
BB
D000046:Academic Medical Centers; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000401:mortality; D002423:Cause of Death; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization / Q000401:mortality*; D009519:New York City / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000139:chemically induced / Q000401:mortality* / Q000628:therapy; D013876:Thiophenes; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000601:surgery
D013876:Thiophenes; C023889:isoprothiolane