Determinants of inducibility of ventricular tachycardia

We analyzed the incidence and predictive factors for induction of clinical ventricular tachycardia (VT) during an electrophysiologic study in 127 patients with structural heart disease and spontaneous VT documented by 12-lead electrocardiography. Eighty-five patients had coronary artery disease (CAD), 24 had idiopathic dilated cardiomyopathy (IDC), and 18 had right ventricular dysplasia (RVD). Clinical variables were age, gender, electrocardiographic patterns of spontaneous arrhythmia, cardiac diagnosis, left ventricular (LV) ejection fraction (EF), infarct location, and presence of LV aneurysm. Clinical VT was induced in 76 patients (60%, group 1) and was not induced in 51 patients (group 2). Clinical VT was induced in 83% of patients with RVD, 58% of patients with CAD, and 50% of patients with IDC (p = 0.07). LVEF tended to be significantly higher in group 1 than in group 2 (p = 0.06). The presence of left QRS axis in the frontal plane during spontaneous VT was significantly associated with a higher inducibility both in the general group (69% vs 46%, p <0.02) and in patients with CAD (70% vs 44%, p <0.02). In patients with CAD, only the presence of a left QRS axis was significantly associated with a higher inducibility. A multivariate analysis identified only the left QRS axis as a significant and independent predictor of induction of clinical VT. The association of a leftward axis with inducibility suggests that vectorial factors in the depolarization wavefronts may be related to inducibility since conventional stimulation is performed from the right ventricle, producing a leftward axis in most cases.