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Predictive value of ventricular arrhythmia inducibility for subsequent ventricular tachycardia or ventricular fibrillation in Multicenter Automatic Defibrillator Implantation Trial (MADIT) II patients.

Publication ,  Journal Article
Daubert, JP; Zareba, W; Hall, WJ; Schuger, C; Corsello, A; Leon, AR; Andrews, ML; McNitt, S; Huang, DT; Moss, AJ; MADIT II Study Investigators,
Published in: J Am Coll Cardiol
January 3, 2006

UNLABELLED: In the Multicenter Automatic Defibrillator Implantation Trial (MADIT) II, implantable cardioverter-defibrillator (ICD)-randomized patients underwent electrophysiologic testing. Both inducible and noninducible patients received an ICD. We correlated inducibility with the occurrence of subsequent ventricular tachycardia (VT) or ventricular fibrillation (VF). Intracardiac ICD electrograms for subsequent events were analyzed to categorize the spontaneous arrhythmia as VT or VF. The two-year Kaplan-Meier event rate for VT in inducible patients was 29.0% versus 19.3% in noninducible patients. However, ICD therapy for spontaneous VF was less common at two years in inducible patients (3.2%) than in noninducible patients (8.6%). In the MADIT II study, inducibility predicted an increased likelihood of VT but decreased VF. OBJECTIVES: We correlated electrophysiologic inducibility with spontaneous ventricular tachycardia (VT) or ventricular fibrillation (VF) in the Multicenter Automatic Defibrillator Implantation Trial (MADIT) II. BACKGROUND: In the MADIT II study, 593 (82%) of 720 implantable cardioverter-defibrillator (ICD) randomized patients underwent electrophysiologic testing. Patients received an ICD whether they were inducible or not. METHODS: A "standard" inducibility definition included sustained monomorphic or polymorphic VT induced with three or fewer extrastimuli or VF induced with two or fewer extrastimuli. We compared a narrow inducibility definition (only monomorphic VT) and a broad definition (standard definition plus VF with three extrastimuli). We used ICD-stored electrograms to categorize spontaneous VT or VF. RESULTS: Inducible patients (standard definition) had a greater likelihood of experiencing ICD therapy for VT than noninducible patients (p = 0.023). Unexpectedly, ICD therapy for spontaneous VF was less common (p = 0.021) in inducible patients than in noninducible patients. The two-year Kaplan-Meier event rate for VT or VF was 29.4% for inducible patients and 25.5% for noninducible patients. Standard inducibility did not predict the combined end point of VT or VF (p = 0.280, by log-rank analysis). The narrow inducibility definition outperformed the standard definition, whereas the broad definition appeared inferior to the standard definition. CONCLUSIONS: In the MADIT II study patients, inducibility was associated with an increased likelihood of VT. Noninducible MADIT II study subjects using this electrophysiologic protocol had a considerable VT event rate and a higher VF event rate than inducible patients. Induction of polymorphic VT or VF, even with double extrastimuli, appears less relevant than induction of monomorphic VT.

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

January 3, 2006

Volume

47

Issue

1

Start / End Page

98 / 107

Location

United States

Related Subject Headings

  • Ventricular Fibrillation
  • Tachycardia, Ventricular
  • Predictive Value of Tests
  • Middle Aged
  • Male
  • Humans
  • Female
  • Electrophysiologic Techniques, Cardiac
  • Defibrillators, Implantable
  • Cardiovascular System & Hematology
 

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Daubert, J. P., Zareba, W., Hall, W. J., Schuger, C., Corsello, A., Leon, A. R., … MADIT II Study Investigators, . (2006). Predictive value of ventricular arrhythmia inducibility for subsequent ventricular tachycardia or ventricular fibrillation in Multicenter Automatic Defibrillator Implantation Trial (MADIT) II patients. J Am Coll Cardiol, 47(1), 98–107. https://doi.org/10.1016/j.jacc.2005.08.049
Daubert, James P., Wojciech Zareba, W Jackson Hall, Claudio Schuger, Andrew Corsello, Angel R. Leon, Mark L. Andrews, et al. “Predictive value of ventricular arrhythmia inducibility for subsequent ventricular tachycardia or ventricular fibrillation in Multicenter Automatic Defibrillator Implantation Trial (MADIT) II patients.J Am Coll Cardiol 47, no. 1 (January 3, 2006): 98–107. https://doi.org/10.1016/j.jacc.2005.08.049.
Daubert JP, Zareba W, Hall WJ, Schuger C, Corsello A, Leon AR, Andrews ML, McNitt S, Huang DT, Moss AJ, MADIT II Study Investigators. Predictive value of ventricular arrhythmia inducibility for subsequent ventricular tachycardia or ventricular fibrillation in Multicenter Automatic Defibrillator Implantation Trial (MADIT) II patients. J Am Coll Cardiol. 2006 Jan 3;47(1):98–107.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

January 3, 2006

Volume

47

Issue

1

Start / End Page

98 / 107

Location

United States

Related Subject Headings

  • Ventricular Fibrillation
  • Tachycardia, Ventricular
  • Predictive Value of Tests
  • Middle Aged
  • Male
  • Humans
  • Female
  • Electrophysiologic Techniques, Cardiac
  • Defibrillators, Implantable
  • Cardiovascular System & Hematology