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Predictors of ventricular tachycardia induction in syncopal patients with mild to moderate left ventricular dysfunction
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Abstract
Methods: A total of 53 consecutive patients with mild to moderate LVD and history of undetermined syncope underwent EPS. Sinus node function, His-Purkinje system conduction and ventricular electrical stability were evaluated.
Results: Twenty eight patients (52.8%) had induction of sustained monomorphic ventricular tachycardia (VT) and five (9.4%) patients had a sustained ventricular arrhythmia other than monomorphic VT (ventricular flutter, ventricular fibrillation, and polymorphic VT) induced during EPS. Abnormal sinus node function and/or His-Purkinje system conduction was found in five (9.4%) patients. Age, gender, history of myocardial infarction, type of underlying heart disease and history of revascularization were not predictors of VT induction. Wide QRS morphology independently, and lower left ventricular ejection fraction and presence of pathologic q wave in precordial leads dependently, could increase risk of VT induction.
Conclusions: The EPS can determine which patient with syncope and mild to moderate LVD is likely to benefit from placing an ICD for prevention of sudden cardiac death. Pathologic precordial q wave, wide QRS morphology and lower left ventricular ejection fraction could be predictors of VT induction during EPS. Wide QRS morphology has an independent effect in this category.
Abstract
Methods: A total of 53 consecutive patients with mild to moderate LVD and history of undetermined syncope underwent EPS. Sinus node function, His-Purkinje system conduction and ventricular electrical stability were evaluated.
Results: Twenty eight patients (52.8%) had induction of sustained monomorphic ventricular tachycardia (VT) and five (9.4%) patients had a sustained ventricular arrhythmia other than monomorphic VT (ventricular flutter, ventricular fibrillation, and polymorphic VT) induced during EPS. Abnormal sinus node function and/or His-Purkinje system conduction was found in five (9.4%) patients. Age, gender, history of myocardial infarction, type of underlying heart disease and history of revascularization were not predictors of VT induction. Wide QRS morphology independently, and lower left ventricular ejection fraction and presence of pathologic q wave in precordial leads dependently, could increase risk of VT induction.
Conclusions: The EPS can determine which patient with syncope and mild to moderate LVD is likely to benefit from placing an ICD for prevention of sudden cardiac death. Pathologic precordial q wave, wide QRS morphology and lower left ventricular ejection fraction could be predictors of VT induction during EPS. Wide QRS morphology has an independent effect in this category.
Keywords
syncope; left ventricular dysfunction; electrophysiology study
About this articleTitle
Predictors of ventricular tachycardia induction in syncopal patients with mild to moderate left ventricular dysfunction
Journal
Issue
Pages
327-331
Published online
2009-05-12
Bibliographic record
Cardiol J 2009;16(4):327-331.
Keywords
syncope
left ventricular dysfunction
electrophysiology study
Authors
Amir Farjam Fazelifar
Peyman Ashrafi
Majid Haghjoo
Zahra Ojaghi Haghighi
Hooman Bakhshandeh Abkenar
Ashrafossadat Ashour
Shahrbanou Azari
Azam Forghanian
Mohammad Ali Sadr-Ameli