Non-sustained ventricular tachycardia in coronary artery disease: predictive value of the frequency, duration and rate for induction of sustained ventricular tachyarrhythmias during programmed ventricular stimulation

Identification of high risk patients with coronary artery disease (CAD) pro ne to sudden cardiac death still remains a difficult issue. In 211 patients with CAD diagnosed by coronary angiography and documented n on-sustained ventricular tachycardia (NSVT), programmed ventricular stimula tion (PVS) was performed. NSVTs documented during Holter monitoring were an alysed concerning frequency, duration and rate. To relate those parameters to the inducibility of sustained monomorphic ventricular tachycardias (MVT) during PVS, the total population was divided in different groups; patients with 1, 2-5 or >5 salves within 24 h; patients having salves with a rate o f greater than or equal to 150/min or < 150/min; patients with 3-5, 6-10 or > 10 consecutive extra beats. It could be demonstrated that in patients wi th CAD and NSVTs, induction of MVTs during PVS is more likely if the rate o f the spontaneously occurring NSVT is greater than or equal to 150/min(22.1 vs 8.9%; p = 0.042). In contrast, there is apparently no correlation betwe en the duration and incidence of NSVTs and the prevalence of MVTs during PV S. Multivariate analysis revealed the rate of documented NSVTs (odds ratio 2.98, p = 0.0314) and a decrease of left ventricular ejection fraction (odd s ratio 1.69; p = 0.0013) as independent risk factors for the inducibility of MVTs. Conclusions CAD patients with fast salves (greater than or equal t o 150 beats/min) and reduced left ventricular ejection fraction are more li kely to reveal inducible MVT during PVS and should, therefore, preferably b e subjected to invasive risk stratification. The number of salves per day a nd the number of consecutive beats, on the other hand, do not seem to be of relevant predictive value.