Pattern of initiation of monomorphic ventricular tachycardia in recorded intracardiac electrograms

By analyzing stored intracardiac electrograms during spontaneous monomorphic ventricular tachycardia (VT), we examined the patterns of the VT initiation in a group of patients with implantable cardioverter defibrillators (ICDs).

Stored electrograms (EGMs) were monomorphic VTs and at least 5 beats before the initiation and after the termination of VT were analyzed. Cycle length, sinus rate, and the prematurity index for each episode were noted.

We studied 182 episodes of VT among 50 patients with ICDs. VPC-induced (extrasystolic initiation) episode was the most frequent pattern (106; 58%) followed by 76 episodes (42%) in sudden-onset group. Among the VPC-induced group, VPCs in 85 episodes (80%) were different in morphology from subsequent VT. Sudden-onset episodes had longer cycle lengths (377+/-30ms) in comparison with the VPC-induced ones (349+/-29ms; P= 0.001). Sinus rate before VT was faster in the sudden-onset compared to that in VPC-induced one (599+/-227ms versus 664+/-213ms; P=0.005). Both of these episodes responded similarly to ICD tiered therapy. There was no statistically significant difference in coupling interval, prematurity index, underlying heart disease, ejection fraction, and antiarrhythmic drug usage between two groups (P=NS).

Dissimilarities between VT initiation patterns could not be explained by differences in electrical (coupling interval, and prematurity index) or clinical (heart disease, ejection fraction, and antiarrhythmic drug) variables among the patients. There is no association between pattern of VT initiation and the success rate of electrical therapy.