Mode of induction of ventricular tachycardia and prognosis in patients with coronary disease

The multicenter unsustained tachycardia trial (MUSTT)

Jonathan P. Piccini, Gail E. Hafley, Kerry L. Lee, John Devens Fisher, Mark E. Josephson, Eric N. Prystowsky, Alfred E. Buxton

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Mode of Induction in MUSTT. Introduction: Programmed stimulation is an important prognostic tool in the evaluation of patients with an ejection fraction ≤40% after myocardial infarction. Many believe that ventricular tachycardia (VT) requiring 3 ventricular extrastimuli (VES) for induction is less likely to occur spontaneously and has less predictive value. However, it is unknown whether the mode of VT induction is associated with long-term prognosis. Methods and Results: We analyzed a cohort of 371 patients enrolled in MUSTT who had inducible monomorphic VT and who were not treated with antiarrhythmic drugs or an implantable cardioverter defibrillator during the trial. Patients in whom sustained VT was induced with 1 or 2 VES or burst pacing (single VES n = 15, double VES n = 127, burst n = 7, total n = 149) were compared with those in whom VT was induced with 3 VES (n = 222). Compared with the others, patients requiring 3 VES were closer to their most recent myocardial infarction (17 vs 51 months, P = 0.035) and showed a trend toward a lower ejection fraction (26% vs 30%, P = 0.057). VT requiring 3 VES had a shorter cycle length (240 vs 260 ms, P < 0.001). Despite these findings, there was no difference in the incidence of arrhythmic death or cardiac arrest (HR 1.02; 95% CI 0.69-1.51) or all-cause mortality (HR 1.03; 95% CI 0.76-1.39) according to the mode of induction in adjusted analyses. Conclusions: The prognostic significance of VT induced by 3 VES is similar to that of VT induced by 1 or 2 VES, or burst pacing, in patients with coronary disease and abnormal LV function. (J Cardiovasc Electrophysiol, Vol. 20, pp. 850-855, August 2009)

Original languageEnglish (US)
Pages (from-to)850-855
Number of pages6
JournalJournal of Cardiovascular Electrophysiology
Volume20
Issue number8
DOIs
StatePublished - Aug 2009

Fingerprint

Ventricular Tachycardia
Tachycardia
Coronary Disease
Myocardial Infarction
Implantable Defibrillators
Anti-Arrhythmia Agents
Heart Arrest
Mortality
Incidence

Keywords

  • Coronary artery disease
  • Electrophysiology testing
  • Implantable cardioverter defibrillator
  • Sudden death
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Mode of induction of ventricular tachycardia and prognosis in patients with coronary disease : The multicenter unsustained tachycardia trial (MUSTT). / Piccini, Jonathan P.; Hafley, Gail E.; Lee, Kerry L.; Fisher, John Devens; Josephson, Mark E.; Prystowsky, Eric N.; Buxton, Alfred E.

In: Journal of Cardiovascular Electrophysiology, Vol. 20, No. 8, 08.2009, p. 850-855.

Research output: Contribution to journalArticle

Piccini, Jonathan P. ; Hafley, Gail E. ; Lee, Kerry L. ; Fisher, John Devens ; Josephson, Mark E. ; Prystowsky, Eric N. ; Buxton, Alfred E. / Mode of induction of ventricular tachycardia and prognosis in patients with coronary disease : The multicenter unsustained tachycardia trial (MUSTT). In: Journal of Cardiovascular Electrophysiology. 2009 ; Vol. 20, No. 8. pp. 850-855.
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abstract = "Mode of Induction in MUSTT. Introduction: Programmed stimulation is an important prognostic tool in the evaluation of patients with an ejection fraction ≤40{\%} after myocardial infarction. Many believe that ventricular tachycardia (VT) requiring 3 ventricular extrastimuli (VES) for induction is less likely to occur spontaneously and has less predictive value. However, it is unknown whether the mode of VT induction is associated with long-term prognosis. Methods and Results: We analyzed a cohort of 371 patients enrolled in MUSTT who had inducible monomorphic VT and who were not treated with antiarrhythmic drugs or an implantable cardioverter defibrillator during the trial. Patients in whom sustained VT was induced with 1 or 2 VES or burst pacing (single VES n = 15, double VES n = 127, burst n = 7, total n = 149) were compared with those in whom VT was induced with 3 VES (n = 222). Compared with the others, patients requiring 3 VES were closer to their most recent myocardial infarction (17 vs 51 months, P = 0.035) and showed a trend toward a lower ejection fraction (26{\%} vs 30{\%}, P = 0.057). VT requiring 3 VES had a shorter cycle length (240 vs 260 ms, P < 0.001). Despite these findings, there was no difference in the incidence of arrhythmic death or cardiac arrest (HR 1.02; 95{\%} CI 0.69-1.51) or all-cause mortality (HR 1.03; 95{\%} CI 0.76-1.39) according to the mode of induction in adjusted analyses. Conclusions: The prognostic significance of VT induced by 3 VES is similar to that of VT induced by 1 or 2 VES, or burst pacing, in patients with coronary disease and abnormal LV function. (J Cardiovasc Electrophysiol, Vol. 20, pp. 850-855, August 2009)",
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T2 - The multicenter unsustained tachycardia trial (MUSTT)

AU - Piccini, Jonathan P.

AU - Hafley, Gail E.

AU - Lee, Kerry L.

AU - Fisher, John Devens

AU - Josephson, Mark E.

AU - Prystowsky, Eric N.

AU - Buxton, Alfred E.

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KW - Coronary artery disease

KW - Electrophysiology testing

KW - Implantable cardioverter defibrillator

KW - Sudden death

KW - Ventricular tachycardia

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