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CLINICAL STUDY

Significance of inducible ventricular fibrillation in patients with coronary artery disease and unexplained syncope

^a Department of Medicine, Division of Cardiology, The New York Hospital-Cornell Medical Center, New York, New York, USA

Manuscript received July 31, 2000; revised manuscript received March 27, 2001, accepted April 10, 2001.

Reprint requests and correspondence: Dr. Bruce B. Lerman, Division of Cardiology, The New York Hospital-Cornell Medical Center, 525 East 68th Street, Starr 4, New York, New York 10021
blerman{at}med.cornell.edu

OBJECTIVES

This study was designed to determine the incidence and prognostic significance of inducible ventricular fibrillation (VF) in patients with coronary artery disease (CAD) and unexplained syncope.

BACKGROUND

Current American College of Cardiology/American Heart Association practice guidelines recommend implantation of internal cardioverter-defibrillators (ICDs) in patients with unexplained syncope in whom either ventricular tachycardia (VT) or VF is inducible during electrophysiologic (EP) testing. Although the prognostic significance of inducible monomorphic VT is known, the significance of inducible VF remains undefined.

METHODS

We evaluated 118 consecutive patients with CAD and unexplained syncope who underwent EP testing. Sustained monomorphic VT was inducible in 53 (45%) patients; in 20 (17%) patients, VF was the only inducible arrhythmia; and no sustained ventricular arrhythmia was inducible in the remaining 45 (38%) patients. The latter two groups of 65 (55%) patients make up the study population.

RESULTS

There were 16 deaths among the study population during a follow-up period of 25.3 ± 19.6 months. The overall one- and two-year survival in these patients was 89% and 81%, respectively. No significant difference in survival was observed between patients with and without inducible VF (80% power to detect a fourfold survival difference).

CONCLUSIONS

In 17% of patients with CAD and unexplained syncope, VF is the only inducible ventricular arrhythmia. Within the limits of this pilot study, long-term follow-up of patients with and without inducible VF demonstrates no difference in survival between the two groups. Therefore, the practice of ICD implantation in patients with CAD, unexplained syncope and inducible VF, especially with triple ventricular extrastimuli, may merit reconsideration.

Abbreviations and Acronyms   AV = atrioventricular   CAD = coronary artery disease   EP = electrophysiologic   ICD = implantable cardioverter-defibrillator   LV = left ventricle, left ventricular   LVEF = left ventricular ejection fraction   MI = myocardial infarction   VF = ventricular fibrillation   VT = ventricular tachycardia

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