Journal of Isfahan Medical School

Journal of Isfahan Medical School

Prognostic Value of Ventriculoatrial Conduction on Programmed Ventricular Stimulation in Patients Suspicious for Ventricular Tachyarrhythmia

Document Type : Original Article (s)

Authors
Mohammad Reza Samiei nasab 1
Azam Soleimani 2
Mohammad Reza Dehghani 3
1 Assistant Professor, Department of Pacemaker and Electrophysiology, Chamran Heart Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
2 Cardiologist, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
3 Assistant Professor, Department of Pacemaker and Electrophysiology, Seied-O-Shohada Heart Hospital, Orumieh University of Medical Sciences, Orumieh, Iran.
Abstract
Background: Prediction of ventricular tachycardia (VT) inducibility through clinical and paraclinical predictors and ability of ventriculoatrial (VA) conduction can help to identify high risk patients easier.Methods: Fifty four patients suspicious for ventricular tachyarrhythmia underwent electrophysiologic study for basic measurements and programmed stimulation for ventricular tachycardia induction, electrocardiography and echocardiography during October 2007-October 2009.Finding: The mean age of participants was 59.4  13.9 years. Forty three patients (79.6%) were male and 39 patients (72.2%) had history of ischemic heart disease (IHD). ventricular tachycardia was induced in 30 patients (55.6%). Ventriculoatrial conduction was recorded in 38.9% of patients (21/54). Ventricular tachycardia was induced in 52.4% of patients (11/21) with ventriculoatrial conduction versus 57.6% (19/33) in ventriculoatrial dissociate patients (P = 0.3). Mean of ventriculoatrial Wenchebach point (VAWP) was 400  96.6 and 393  103.6 ms in ventricular tachycardia inducible and non inducible patients respectively (P = 0.4). Presence of ischemic heart disease and lower left ventricular ejection fraction (LVEF) were associated with increased probability of ventricular tachycardia induction (P = 0.008 and 0.04 respectively). Presence of ischemic heart disease predicts ventricular tachycardia inducibility independently. Patients with inducible ventricular tachycardia had slightly shorter atrial-His (AH) interval (97.33  30.4 and 112.1  42.6 ms, P = 0.07).Conclusion: Ventricular tachycardia induction was very slightly more common in ventriculoatrial dissociate patients but we could not prove it. Presence of ischemic heart disease independently and lower left ventricular ejection fraction dependently could predict ventricular tachycardia inducibility.
Keywords
Electrophysiology study
Heart conduction system
Ischemia
Ventricular Tachycardia
  1. Lopez AD, Matheres CD, Ezzati M. Global Burden of Disease and Risk Factors. Washington (DC): Oxford University Press; 2006.
  2. Myerburg RJ. Sudden cardiac death: exploring the limits of our knowledge. J Cardiovasc Electrophysiol 2001; 12(3): 369-81.
  3. Vreede-Swagemakers JJ, Gorgels AP, Dubois-Arbouw WI, van Ree JW, Daemen MJ, Houben LG, et al. Out-of-hospital cardiac arrest in the 1990's: a population-based study in the Maastricht area on incidence, characteristics and sur-
  4. vival. J Am Coll Cardiol 1997; 30(6): 1500-5.
  5. Andrews NP, Fogel RI, Pelargonio G, Evans JJ, Prystowsky EN. Implantable defibrillator event rates in patients with unexplained syncope and inducible sustained ventricular tachyarrhythmias: a comparison with patients known to have sustained ventricular tachycardia. J Am Coll Cardiol 1999; 34(7): 2023-30.
  6. Menon V, Steinberg JS, Akiyama T, Beckman K, Carillo L, Kutalek S. Implantable cardioverter defibrillator discharge rates in patients with unexplained syncope, structural heart disease, and inducible ventricular tachycardia at electrophysiologic study. Clin Cardiol 2000; 23(3): 195-200.
  7. Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 2005; 352(3): 225-37.
  8. Buxton AE, Lee KL, Fisher JD, Josephson ME, Prystowsky EN, Hafley G. A randomized study of the prevention of sudden death in patients with coronary artery disease. Multicenter Unsustained Tachycardia Trial Investigators. N Engl J Med 1999; 341(25): 1882-90.
  9. Brodsky MA, Mitchell LB, Halperin BD, Raitt MH, Hallstrom AP. Prognostic value of baseline electrophysiology studies in patients with sustained ventricular tachyarrhythmia: the Antiarrhythmics Versus Implantable Defibrillators (AVID) trial. Am Heart J 2002; 144(3): 478-84.
  10. Ortiz M, Almendral J, Lopez-Palop R, Villacastin J, Arenal A. Determinants of inducibility of ventricular tachycardia. Am J Cardiol 2001; 87(11): 1255-9.
  11. Fazelifar AF, Ashrafi P, Haghjoo M, Haghighi ZO, Abkenar HB, Ashour A, et al. Predictors of ventricular tachycardia induction in syncopal patients with mild to moderate left ventricular dysfunction. Cardiol J 2009; 16(4): 327-31.
  12. Gillis AM, Sheldon RS, Wyse DG, Duff HJ, Cassidy MR, Mitchell LB. Clinical and electrophysiologic predictors of ventricular tachyarrhythmia recurrence in patients with implantable cardioverter defibrillators. J Cardiovasc Electrophysiol 2003; 14(5): 492-8.
  13. Gradel C, Jain D, Batsford WP, Wackers FJ, Zaret BL. Relationship of scar and ischemia to the results of programmed electrophysiological stimulation in patients with coronary artery disease. J Nucl Cardiol 1997; 4(5): 379-86.
  14. Wnuk-Wojnar AM, Giec L, Drzewiecki J, Trusz-Gluza M, Dabrowski A, Pasyk S. Predictors of ventricular tachycardia inducibility in programmed electrical stimulation and the effectiveness of serial drug testing: Polish multicenter study. Pacing Clin Electrophysiol 1990; 13(12 Pt 2): 2127-32.
  15. Hammill SC, Trusty JM, Wood DL, Bailey KR, Vatterott PJ, Osborn MJ, et al. Influence of ventricular function and presence or absence of coronary artery disease on results of electrophysiologic testing for asymptomatic nonsustained ventricular tachycardia. Am J Cardiol 1990; 65(11): 722-8.
  16. Militianu A, Salacata A, Meissner MD, Grill C, Mahmud R, Palti AJ, et al. Ventriculoatrial conduction capability and prevalence of 1:1 retrograde conduction during inducible sustained monomorphic ventricular tachycardia in 305 implantable cardioverter defibrillator recipients. Pacing Clin Electrophysiol 1997; 20(10 Pt 1): 2378-84.
  17. Nanthakumar K, Dorian P, Paquette M, Greene M, Edwards J, Heng D, et al. Is inappropriate implantable defibrillator shock therapy predictable? J Interv Card Electrophysiol 2003; 8(3): 215-20.
  18. Strickberger SA, Benson DW, Biaggioni I, Callans DJ, Cohen MI, Ellenbogen KA, et al. AHA/ACCF scientific statement on the evaluation of syncope: from the American Heart Association Councils on Clinical Cardiology, Cardiovascular Nursing, Cardiovascular Disease in the Young, and Stroke, and the Quality of Care and Outcomes Research Interdisciplinary Working Group; and the American College of Cardiology Foundation In Collaboration With the Heart Rhythm Society. J Am Coll Cardiol 2006; 47(2): 473-84.
  19. Zipes DP, DiMarco JP, Gillette PC, Jackman WM, Myerburg RJ, Rahimtoola SH, et al. Guidelines for clinical intracardiac electrophysiological and catheter ablation procedures. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Intracardiac Electrophysiologic and Catheter Ablation Procedures), developed in collaboration with the North American Society of Pacing and Electrophysiology. J Am Coll Cardiol 1995; 26(2): 555-73.
  20. Josephson ME, Dana HC. ElectroPhysiologic investigation: General concepts. In: Josephson ME, Editor. Clinical cardiac electrophysiology: techniques and interpretations. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2008. p. 22, 24, 40.
Journal of Isfahan Medical School
Volume 28, Issue 113 - Serial Number 113
September and October 2011
Pages 725-733

  • Receive Date 29 December 2010
  • Accept Date 06 April 2022