Arrhythmias & electrophysiology

Optimizing electrophysiology studies to prevent sudden cardiac death after myocardial infarction

EuropacePublished Prospective cohort study

Authors' conclusion

Ventricular tachycardia induced with shorter coupling intervals was associated with higher risk of spontaneous ventricular tachyarrhythymia on follow-up, indicating that the final extrastimulus coupling interval at EPS early after MI should be determined by ventricular refractoriness. Induced VT with possible origin from left ventricle was associated with increased risk of spontaneous ventricular tachyarrhythmia recurrence or death.

Study context

Population
Patients with left ventricular ejection fraction (LVEF) ≤ 40% undergoing electrophysiology study (EPS) days 3–5 after myocardial infarction (MI), 2004–2017
Exposure
Final extrastimulus coupling interval at EPS <200 ms vs >200 ms; Right bundle branch block (RBBB) vs other morphology of induced ventricular tachycardia (VT)
Outcome
Spontaneous ventricular tachyarrhythmia occurrence and all-cause mortality
Methodological detailsconsecutive patients
  • Consecutive patients

Main finding

As reported in the abstract

Spontaneous ventricular tachyarrhythmia

P < 0.001

Shorter coupling interval of final extrastimulus inducing VT associated with higher risk of spontaneous ventricular tachyarrhythmia
P < 0.001

Observational data: associations, not effects.

Further findings

OutcomeHRP value
All-cause mortality, RBBB morphology of induced VT (possible LV origin)3.2P = 0.044
Spontaneous ventricular tachyarrhythmia recurrence or mortality, RBBB morphology of induced VT1.8P = 0.043

Original publication

Optimizing electrophysiology studies to prevent sudden cardiac death after myocardial infarction. Europace. Published 20 July 2023. doi:10.1093/europace/euad219

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