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Significance of sustained monomorphic ventricular tachycardia induced with short coupling intervals in patients with ischemic cardiomyopathy

      Programmed ventricular stimulation has emerged as an important tool for identifying patients at risk for sudden cardiac death, especially in those with coronary artery disease, left ventricular dysfunction, and nonsustained ventricular tachycardia (VT).
      • Moss A.J.
      • Hall J.W.
      • Cannon D.S.
      • Daubert J.P.
      • Higgins S.L.
      • Klein H.
      • Levine J.H.
      • Saksena S.
      • Waldo A.L.
      • Wilber D.
      • Brown M.W.
      • Heo M.
      Improved survival with implantable defibrillator in patients with coronary artery disease at high risk of ventricular arrhythmia.
      ,
      • Buxton A.E.
      • Lee K.L.
      • Fisher J.D.
      • Josephson M.E.
      • Prystowsky E.N.
      • Hafley G.
      A randomized study of the prevention of sudden death in patients with coronary artery disease.
      ,
      • Buxton A.E.
      • Lee K.L.
      • DiCarlo L.
      • Gold M.R.
      • Greer G.S.
      • Prystowsky E.N.
      • O’Toole M.F.
      • Tang A.
      • Fisher J.D.
      • Coromilas J.
      • Talajic M.
      • Hafley G.
      Electrophysiologic testing to identify patients with coronary artery disease who are at risk for sudden death.
      Most induction protocols include programmed stimulation with up to triple ventricular extrastimuli at 2 cycle lengths from 2 right ventricular sites.
      • Doherty J.U.
      • Kienzle M.G.
      • Waxman H.L.
      • Buxton A.E.
      • Marchlinski F.E.
      • Josephson M.E.
      Programmed ventricular stimulation at a second right ventricular site an analysis of 100 patients, with special references to sensitivity, specificity and characteristics of patients with induced ventricular tachycardia.
      ,
      • Brugada P.
      • Green M.
      • Abdollah H.
      • Wellens H.J.
      Significance of ventricular arrhythmias initiated by programmed ventricular stimulation the importance of the type of ventricular arrhythmia induced and the number of premature stimuli required.
      ,
      • Waldo A.L.
      • Akhtar M.
      • Brugada P.
      • Henthorn R.W.
      • Scheinman M.M.
      • Ward D.E.
      • Wellens H.J.
      The minimally appropriate electrophysiologic study for the initial assessment of patients with documented sustained monomorphic ventricular tachycardia.
      ,
      • Wellens H.J.
      • Brugada P.
      • Stevenson W.G.
      Programmed electrical stimulation of the heart in patients with life-threatening ventricular arrhythmias what is the significance of induced arrhythmias and what is the correct stimulation protocol?.
      ,
      • Brembilla-Perrot B.
      • Houriez P.
      • Claudon O.
      • Preiss J.P.
      • Beurrier D.
      • Louis P.
      • Terrier de la Chaise A.
      Long-term reproducibility of ventricular tachycardia induction with electrophysiological testing in patients with coronary heart disease and depressed left ventricular ejection fraction.
      Because of concerns regarding specificity, many electrophysiology laboratories and multicenter trials like the Multicenter Automatic Defibrillator Implantation Trial (MADIT) preclude stimulation at coupling intervals <200 to 180 ms.
      • Moss A.J.
      • Hall J.W.
      • Cannon D.S.
      • Daubert J.P.
      • Higgins S.L.
      • Klein H.
      • Levine J.H.
      • Saksena S.
      • Waldo A.L.
      • Wilber D.
      • Brown M.W.
      • Heo M.
      Improved survival with implantable defibrillator in patients with coronary artery disease at high risk of ventricular arrhythmia.
      ,
      • Mann D.E.
      • Luck J.C.
      • Griffin J.C.
      • Herre J.M.
      • Limacher M.C.
      • Magro S.A.
      • Robertson N.W.
      • Wyndham C.R.
      Induction of clinical ventricular tachycardia using programmed stimulation value of third and fourth extrastimuli.
      ,
      • Morady F.
      • Dicarlo J.R.
      • Baerman J.M.
      • de Buitleir M.
      Comparison of coupling intervals that induce clinical and nonclinical forms of ventricular tachycardia during programmed stimulation.
      ,
      • Fisher J.D.
      • Kim S.G.
      • Ferrick K.J.
      • Artoul S.G.
      • Fink D.
      • Roth J.A.
      • Johnston D.R.
      • Williams H.R.
      Programmed electrical stimulation of the ventricle an efficient, sensitive, and specific protocol.
      To determine the specificity of a protocol that permitted the introduction of ventricular extrastimuli at coupling intervals <200 ms, we evaluated patients with coronary artery disease and left ventricular dysfunction undergoing electrophysiologic study for nonsustained VT, and compared the annualized event rates (sustained VT or ventricular fibrillation [VF] requiring implantable cardioverter-defibrillator [ICD] therapy) in patients in whom sustained monomorphic VT or VF was induced with coupling intervals ≥200 ms with those in whom at least 1 coupling interval was <200 ms. A similar analysis was also performed comparing coupling intervals <180 ms or ≥180 ms.
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        Improved survival with implantable defibrillator in patients with coronary artery disease at high risk of ventricular arrhythmia.
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