Yield of Coronary Assessment in Sustained Monomorphic Ventricular Tachycardia
Ashwin Bhaskaran1, Kasun De Silva2, Samual Turnbull3
1Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, The University of Sydney, Sydney, NSW, Australia. Electronic address: https://www.twitter.com/drashwinb.
Insights
Coronary assessment in sustained monomorphic ventricular tachycardia (SMVT) has limited utility, as acute coronary occlusion is rare. Revascularization alone does not prevent VT recurrence, indicating a need for comprehensive treatment strategies.
Area of Science:
- Cardiology
- Electrophysiology
- Interventional Cardiology
Background:
- Coronary artery disease (CAD) assessment is common in sustained monomorphic ventricular tachycardia (SMVT) patients.
- The diagnostic yield and treatment impact of coronary assessment in SMVT are not well-defined.
Purpose of the Study:
- To determine CAD prevalence in SMVT patients.
- To identify factors influencing coronary assessment referral.
- To evaluate clinical outcomes based on CAD management (revascularization vs. medical therapy).
Main Methods:
- Retrospective analysis of 249 consecutive SMVT patients admitted between 2017-2022.
- Coronary assessment was performed in 140 patients.
- Outcomes compared between revascularized and medically managed CAD patients.
Main Results:
- Significant CAD found in 34% of assessed patients; no acute coronary occlusion identified.
- Chest pain and elevated troponin levels influenced referral but did not predict significant CAD.
- Revascularization (PCI or CABG) in 19 patients did not significantly reduce VT recurrence compared to medical management.
- A revascularization-only strategy showed a high rate of VT recurrence.
Conclusions:
- Coronary assessment in SMVT patients has a modest yield, with acute coronary occlusion being absent.
- Traditional ischemic indicators do not enhance the yield of coronary assessment.
- Revascularization alone is insufficient to prevent VT recurrence in SMVT patients.
Background:
Coronary assessment is frequently conducted in patients with sustained monomorphic ventricular tachycardia (SMVT); however, its yield and subsequent treatment implications remain unclear. This study aimed to determine the prevalence of coronary artery disease (CAD) in patients presenting with SMVT, factors influencing clinician referral for coronary assessment, and clinical outcomes based on revascularisation or medical management of CAD.
Method:
Consecutive patients presenting with acute SMVT requiring inpatient admission between 2017 and 2022 were identified.
Results:
A total of 249 individual patients with SMVT were identified, with 140 undergoing coronary assessment. Referral for coronary assessment was driven by chest pain (p<0.001) and increased troponin kinetics (p<0.001). No patient with SMVT had an acute coronary occlusion. Significant CAD was found in 48 (34%) patients, and traditional ischaemic features did not predict significant CAD. Nineteen (40%) patients with significant CAD underwent revascularisation (n=15 percutaneous coronary intervention, n=4 coronary artery bypass grafting). There was no significant difference in time to ventricular tachycardia (VT) recurrence between revascularised and medically managed CAD (hazard ratio 1.670; 95% confidence interval 0.756-3.687; p=0.199). A total of five of six patients who underwent a revascularisation-only strategy (no upfront antiarrhythmic therapy or ablation) had VT recurrence (median time to recurrence 8.9 months).
Conclusions:
Despite being frequently performed, coronary assessment in SMVT has only modest yield, with no patients having an acute coronary occlusion. Traditional clinical factors of ischaemia did not improve this yield. Revascularisation alone did not improve freedom from VT.
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