Nonsustained Ventricular Tachycardia in Coronary Artery Disease: Relation to Inducible Sustained Ventricular Tachycardia

  1. Alfred E. Buxton, MD;
  2. Kerry L. Lee, PhD;
  3. Lorenzo DiCarlo, MD;
  4. Debra S. Echt, MD;
  5. John D. Fisher, MD;
  6. G. Stephen Greer, MD;
  7. Mark E. Josephson, MD;
  8. Douglas Packer, MD;
  9. Eric N. Prystowsky, MD;
  10. Mario Talajic, MD; and
  11. for the MUSTT Investigators*
  1. With the technical assistance of Gail E. Hafley, MS, and Pamela M. Smith, RN Grant Support: By grants UO1 HL45700 and UO1 HL45726 from the National Heart, Lung, and Blood Institute, National Institutes of Health, and by grants from C.R. Bard; Berlex Laboratories; Boehringer-Ingelheim Pharmaceuticals; Cardiac Pacemakers/Guidant; Knoll Pharmaceutical; Medtronic; Searle Pharmaceutical; Ventritex; and Wyeth-Ayerst Laboratories. Requests for Reprints: Alfred E. Buxton, MD, Cardiovascular Section, Department of Medicine, Temple University School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140. Current Author Addresses: Dr. Buxton: Cardiovascular Section, Department of Medicine, Temple University School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140.

    Abstract

    Background: Many physicians believe that electrocardiographic characteristics of nonsustained ventricular tachycardia correlate with the risk for sudden death in survivors of myocardial infarction. Sustained ventricular tachycardia induced by programmed electrical stimulation has also been shown to predict sudden death.

    *For a list of additional MUSTT investigators, see the Appendix.

    Objective: To determine whether electrocardiographic characteristics of spontaneous nonsustained ventricular tachycardia can predict the inducibility of sustained ventricular tachycardia by programmed electrical stimulation in patients with coronary artery disease having abnormal ventricular function.

    Design: Observational cohort study.

    Setting: 70 clinical electrophysiology laboratories in the United States and Canada.

    Patients: 1480 consecutive patients with coronary artery disease, left ventricular ejection fraction of 0.40 or less, and asymptomatic nonsustained ventricular tachycardia.

    Intervention: Electrophysiologic study attempting to induce sustained monomorphic ventricular tachycardia.

    Measurements: Daily frequency, duration, and cycle length of spontaneous episodes of nonsustained ventricular tachycardia, measured by standard electrocardiographic recordings.

    Results: No statistically significant difference in the frequency or duration of spontaneous nonsustained ventricular tachycardia was seen between patients with and those without inducible sustained ventricular tachycardia. Rates of spontaneous tachycardia were slightly slower in patients with inducible ventricular tachycardia than in patients without inducible ventricular tachycardia (P = 0.047), but the difference was not clinically significant.

    Conclusion: Electrocardiographic characteristics of spontaneous nonsustained ventricular tachycardia do not predict which patients with coronary artery disease will have inducible sustained ventricular tachycardia.

    Ann Intern.Med. 1996; 125:35-39.

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    1. Ann Intern Med July 1, 1996 vol. 125 no. 1 35-39
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