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CLINICAL RESEARCH: HEART RHYTHM DISORDER

Predictive Value of Ventricular Arrhythmia Inducibility for Subsequent Ventricular Tachycardia or Ventricular Fibrillation in Multicenter Automatic Defibrillator Implantation Trial (MADIT) II Patients

James P. Daubert, MD^_*,_*, Wojciech Zareba, MD, PhD^_*, W. Jackson Hall, PhD, Claudio Schuger, MD, Andrew Corsello, MD, Angel R. Leon, MD^||, Mark L. Andrews, MS^_*, Scott McNitt, MS^_*, David T. Huang, MD^_*, Arthur J. Moss, MD^_* for the MADIT II Study Investigators

^_* Cardiology Unit, Department of Medicine, University of Rochester Medical Center, Rochester, New York
Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York
Department of Medicine, Henry Ford Health System, Detroit, Michigan
Maine Medical Center, Portland, Maine
^|| Department of Medicine, Emory University/Crawford Long Hospital, Atlanta, Georgia

Manuscript received January 8, 2005; revised manuscript received April 13, 2005, accepted August 1, 2005.

^_* Reprint requests and correspondence: Dr. James P. Daubert, Box 679-Cardiology, University of Rochester Medical Center, Rochester, New York 14642. (Email: James_Daubert{at}URMC.Rochester.edu).

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.

Abbreviations and Acronyms   ATP = anti-tachycardia pacing   EP = electrophysiologic   HR = hazard ratio   ICD = implantable cardioverter-defibrillator   MADIT = Multicenter Automatic Defibrillator Implantation Trial   MI = myocardial infarction   RV = right ventricular   VF = ventricular fibrillation   VT = ventricular tachycardia

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