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Multiple monomorphic ventricular tachycardia configurations predict failure of antiarrhythmic drug therapy guided by
R D Mitrani1, L A Biblo, M D Carlson
1Department of Medicine, Case Western Reserve University, University Hospitals of Cleveland, Ohio 44106.
Objectives:
The purpose of this study was to determine whether the induction at electrophysiologic study of sustained monomorphic ventricular tachycardias with multiple QRS complex configurations predicted failure of subsequent serial electrophysiologic study guided antiarrhythmic drug testing.
Background:
Ventricular tachycardias with multiple QRS complex configurations are associated with failure of surgical therapy for ventricular tachycardia. As such, the presence of multiple monomorphic QRS complex ventricular tachycardias during electrophysiologic testing may predict failure of subsequent medical therapy.
Methods:
Fifty-one consecutive patients with coronary artery disease had reproducible induction of monomorphic ventricular tachycardia during a baseline electrophysiologic study. Each patient then underwent a mean of 1.5 antiarrhythmic drug trials. An antiarrhythmic drug regimen that suppressed induction of ventricular tachycardia was identified in 13 (26%) of the 51 patients.
Results:
Patients with only one inducible monomorphic QRS complex ventricular tachycardia at baseline study were more likely to have an antiarrhythmic drug regimen identified that suppressed inducible ventricular tachycardia than were patients with multiple monomorphic QRS complex ventricular tachycardias (12[36%] of 33 patients vs. 1 [6%] of 18, p = 0.04). In seven patients with only one induced configuration of ventricular tachycardia, a second monomorphic ventricular tachycardia with a different QRS complex configuration occurred during attempts at pacing termination of the induced ventricular tachycardia. None of these seven patients then had successful drug suppression of inducible ventricular tachycardia. Thus, 12 (46%) of 26 patients with a single monomorphic QRS complex ventricular tachycardia observed at baseline study had successful serial drug testing compared with 1 (4%) of 25 patients with multiple QRS complex ventricular tachycardia configurations (p = 0.002).
Conclusions:
The induction or observation of multiple monomorphic QRS complex ventricular tachycardias at baseline electrophysiologic study predicted failure of subsequent serial electrophysiologic study--guided antiarrhythmic drug therapy.
Insights
Inducing multiple ventricular tachycardias during electrophysiologic study predicts antiarrhythmic drug therapy failure. Patients with a single ventricular tachycardia type were more likely to achieve successful drug suppression.
Area of Science:
- Cardiology
- Electrophysiology
- Pharmacology
Background:
- Multiple QRS complex ventricular tachycardias are linked to failed surgical treatments for ventricular tachycardia.
- Electrophysiologic testing revealing multiple monomorphic ventricular tachycardias may indicate poor response to antiarrhythmic drug therapy.
Purpose of the Study:
- To assess if inducing sustained monomorphic ventricular tachycardias with diverse QRS configurations during electrophysiologic study predicts treatment failure in subsequent antiarrhythmic drug testing.
- To investigate the predictive value of multiple ventricular tachycardia morphologies on antiarrhythmic drug therapy outcomes.
Main Methods:
- Fifty-one patients with coronary artery disease underwent electrophysiologic studies with reproducible monomorphic ventricular tachycardia induction.
- Patients received an average of 1.5 antiarrhythmic drug trials, with successful suppression defined by the inability to induce ventricular tachycardia.
Main Results:
- Successful antiarrhythmic drug suppression was achieved in 26% of patients (13/51).
- Patients with a single inducible ventricular tachycardia configuration were significantly more likely to achieve successful drug suppression (36% vs. 6%, p=0.04).
- In patients with initially single ventricular tachycardia, the emergence of a second configuration during pacing predicted failed drug suppression (46% vs. 4%, p=0.002).
Conclusions:
- The presence of multiple monomorphic ventricular tachycardias during baseline electrophysiologic study is a significant predictor of failed serial electrophysiologic study-guided antiarrhythmic drug therapy.
- Identifying multiple ventricular tachycardia morphologies can help anticipate challenges in medical management of ventricular tachycardia.