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Mode of Induction of Ventricular Tachycardia and Prognosis in Patients with Coronary Disease: The Multicenter UnSustained Tachycardia Trial (MUSTT)
Article first published online: 10 APR 2009
© 2009 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 20, Issue 8, pages 850–855, August 2009
How to Cite
PICCINI, J. P., HAFLEY, G. E., LEE, K. L., FISHER, J. D., JOSEPHSON, M. E., PRYSTOWSKY, E. N., BUXTON, A. E. and for the MUSTT Investigators (2009), Mode of Induction of Ventricular Tachycardia and Prognosis in Patients with Coronary Disease: The Multicenter UnSustained Tachycardia Trial (MUSTT). Journal of Cardiovascular Electrophysiology, 20: 850–855. doi: 10.1111/j.1540-8167.2009.01469.x
Dr. Fisher reports serving as a consultant for Medtronic, Inc. Dr. Prystowsky reports serving as a consultant for Medtronic, Inc. The other authors report no conflicts.
- Issue published online: 28 JUL 2009
- Article first published online: 10 APR 2009
- Manuscript received 18 December 2008; Revised manuscript received 22 January 2009; Accepted for publication 9 February 2009.
- electrophysiology testing;
- coronary artery disease;
- ventricular tachycardia;
- implantable cardioverter defibrillator;
- sudden death
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.