title: Ventricular flutter induced during electrophysiologic studies in patients with old myocardial infarction: clinical and electrophysiologic predictors, and prognostic significance.
abstract: BACKGROUND
  Induction of ventricular flutter during electrophysiologic (EP) studies (similar to that of ventricular fibrillation [VF]) often is viewed as a nonspecific response with limited prognostic significance. However, data supporting this dogma originate from patients without previously documented ventricular tachyarrhythmias. We examined the significance of ventricular flutter in patients with and without spontaneous ventricular arrhythmias.
  
  
  RESULTS
  We conducted a cohort study of all patients with myocardial infarction (MI) undergoing EP studies at our institution. Of 344 consecutive patients, 181 had previously documented spontaneous sustained ventricular arrhythmias, 61 had suspected ventricular arrhythmias, and 102 had neither. Ventricular flutter was induced in 65 (19%) of the patients. Left ventricular ejection fraction was highest among patients with inducible VF (35 +/- 13), lowest for patients with inducible sustained monomorphic ventricular tachycardia (SMVT; 27 +/- 9), and intermediate for patients with inducible ventricular flutter (30 +/- 10). Similarly, the coupling intervals needed to induce the arrhythmia were shortest for VF (200 +/- 28 msec), intermediate for ventricular flutter (209 +/- 27 msec), and longest for SMVT (230 +/- 35 msec). During 5 +/- 8 years of follow-up, the risk for ventricular tachycardia/VF was high for patients with SMVT and ventricular flutter and low for patients with inducible VF and noninducible patients (46%, 34%, 17%, and 14%, P < 0.005).
  
  
  CONCLUSIONS
  Patients with inducible ventricular flutter appear to be "intermediate" between patients with inducible VF and patients with SMVT in terms of clinical and electrophysiologic correlates. However, the prognostic value of inducible ventricular flutter is comparable to that of SMVT.
authors.affiliation: Department of Cardiology, Tel Aviv-Sourasky Medical Center, Sackler-School of Medicine, Tel Aviv University, Weizman 6, Tel Aviv 64239, Israel. saviskin@tasmc.health.gov.il
authors.forename: Sami
authors.initials: S
authors.lastname: Viskin
authors.forename: Maya
authors.initials: M
authors.lastname: Ish-Shalom
authors.forename: Edward
authors.initials: E
authors.lastname: Koifman
authors.forename: Uri
authors.initials: U
authors.lastname: Rozovski
authors.forename: David
authors.initials: D
authors.lastname: Zeltser
authors.forename: Aharon
authors.initials: A
authors.lastname: Glick
authors.forename: Ariel
authors.initials: A
authors.lastname: Finkelstein
authors.forename: Amir
authors.initials: A
authors.lastname: Halkin
authors.forename: Roman
authors.initials: R
authors.lastname: Fish
authors.forename: Bernard
authors.initials: B
authors.lastname: Belhassen
mesh_terms: D000368:Aged; D015331:Cohort Studies; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000150:complications / Q000209:etiology; D014693:Ventricular Fibrillation / Q000150:complications* / Q000209:etiology*; D016277:Ventricular Function, Left