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The Role of the Transvenous Catheter Electrophysiologic Study in the Evaluation and Management of Ventricular Tachyarrhythmias Associated with Ischemic Heart Disease

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Cardiac Electrophysiology Review

Abstract

The transvenous-catheter electrophysiologic (EP) study has occupied a central position in the investigation and management of patients with ischemic heart disease and a propensity to ventricular tachycardia (VT) or ventricular fibrillation (VF) for more than 25 years. However, demonstration of the superiority of the implantable cardioverter defibrillator (ICD) compared to other approaches to the management of VT/VF has resulted in a decrease in the frequency of use of the EP study in these patients. Nevertheless, the EP study remains a value-added procedure for many patients in this setting. These advantages include demonstration that the clinical arrhythmia is VT/VF when the diagnosis is uncertain, identification of those patients whose VT/VF is actually the result of a supraventricular tachyarrhythmia, identification of VT mechanisms readily amenable to catheter ablation, assessment of the response of a patient's VT to attempts at pace-termination, evaluation of candidacy for ablative VT therapy, prediction of the efficacy of approaches to prevention of VT/VF episodes, risk stratification of patients who have not yet experienced a sustained episode of VT/VF, and continued enhancement of our understanding of the mechanisms and therapeutics of VT/VF. The purpose of this review is to outline our present understanding of the techniques and indications for an EP study in patients with ischemic heart disease.

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References

  1. Wellens HJ, Schuilenburg RM, Durrer D. Electrical stimulation of the heart in patients with ventricular tachycardia. Circulation 1972;46:216–226.

    Google Scholar 

  2. Wu D, Wyndham CR, Denes P, Amat-Y-Leon F, Miller RH, Dhingra RC, Rosen KM. Chronic electrophysiologic study in patients with recurrent paroxysmal tachycardia: A new method for developing successful oral antiarrhythmic therapy. In: Kulbertus HE, ed. Reentrant Arrhythmia: Mechanisms and Treatment, Lancaster PA: MTP Press Limited, 1977:294–311.

    Google Scholar 

  3. Mitchell LB, Geddes LS. Is a baseline electrophysiologic study mandatory for the management of patients with spontaneous, sustained, ventricular tachyarrhythmias? Prog Cardiovasc Dis 1996;38:385–392.

    Google Scholar 

  4. ESVEM Investigators. The ESVEM trial: Electrophysiologic study versus electrocardiographic monitoring for selection of antiarrhythmic therapy of ventricular tachyarrhythmias. Circulation 1989;79:1354–1360.

    Google Scholar 

  5. Das MK, Stein KM, Canilang K, Markowitz SM, Mittal S, Slotwiner DJ, Iwai S, Lerman BB. Significance of sustained monomorphic ventricular tachycardia induced with short coupling intervals in patients with ischemic cardiomyopathy. Am J Cardiol 2002;89:987–990.

    Google Scholar 

  6. Mitchell LB, Sheldon RS, Gillis AM, Connolly SJ, Duff HJ, Gardner MJ, Hui WKK, Ramadan D, Wyse DG. Definition of predicted-effective antiarrhythmic drug therapy for ventricular tachyarrhythmias by the electrophysiologic study approach: Randomized comparison of patient response criteria. J Am Coll Cardiol 1997;30:1346–1353.

    Google Scholar 

  7. Dolack GL, Poole JE, Kudenchuk PJ, Raitt MH, Gleva MJ, Anderson J, Troutman C, Bardy GH. Management of ventricular fibrillation with transvenous defibrillators without baseline electrophysiologic testing or antiarrhythmic drugs. J Cardiovasc Electophysiol 1996;7:197–202.

    Google Scholar 

  8. Buxton AE, Lee KL, Fisher JD, Josephson ME, Prystowski EN, Hafley G. MUSTT investigators. A randomized study of the prevention of sudden death in patients with coronary artery disease. N Engl J Med 1999;341:1882–1890.

    Google Scholar 

  9. AVID Investigators. A comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Engl J Med 1997;337:1576–1583.

    Google Scholar 

  10. Connolly SJ, Gent M, Roberts RS, Dorian P, Roy D, Sheldon RS, Mitchell LB, Green MS, Klein GJ, O'Brien B. CIDS investigators. Canadian implantable defibrillator trial (CIDS): A randomized trial of the implantable cardioverter defibrillator against amiodarone. Circulation 2000;101:1297–1302.

    Google Scholar 

  11. Kuck K-H, Cappato R, Siebels J, Rüppel R. CASH investigators. Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest: The cardiac arrest study Hamburg (CASH). Circulation 2000;102:748–754.

    Google Scholar 

  12. Moss AJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H, Levine JH, Sakseena S, Waldo AL, Wilber D, Brown MW, Heo M. MADIT investigators. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. N Engl J Med 1996;335:1933–1940.

    Google Scholar 

  13. Stevenson WG, Friedman PL, Kocovic D, Sager PT, Saxon LA, Pavri B. Radiofrequency catheter ablation of ventricular tachycardia after myocardial infarction. Circulation 1998;98:308–314.

    Google Scholar 

  14. El-Shalakany A, Hadjis T, Papageorgiou P, Monahan K, Epstein L, Josephson ME. Entrainment/mapping criteria for the prediction of termination of ventricular tachycardia by single radiofrequency lesion in patients with coronary artery disease. Circulation 1999;99:2283–2289.

    Google Scholar 

  15. Rothman SA, Hsia HH, Cossu SF, Chmielewski IL, Buxton AE, Miller JM. Radiofrequency catheter ablation of postinfarction ventricular tachycardia: Long-term success and the significance of inducible nonclinical arrhythmias. Circulation 1997;96:3499–3508.

    Google Scholar 

  16. Schmitt C, Barthel P, Ndrepepa G, Schreieck J, Plewan A, Schömig A, Schmidt G. Value of programmed ventricular stimulation for prophylactic internal cardioverterdefibrillator implantation in postinfarction patients preselected by noninvasive risk stratifiers. J Am Coll Cardiol 2001;37:1901–1907.

    Google Scholar 

  17. Buxton AE, Lee KL, DiCarlo L, Gold MR, Greer GS, Prystowski EN, O'Toole MF, Tang T, Fisher JD, Coromilas J, Talajic M, Hafley G. MUSTT investigators. Electrophysiologic testing to identify patients with coronary artery disease who are at risk for sudden death. N Engl J Med 2000;342:1937–1945.

    Google Scholar 

  18. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, Brown MW, Andrews ML. MADIT-II investigators. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction.NEngl J Med 2002;346:877–883.

    Google Scholar 

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Authors and Affiliations

  1. Department of Cardiac Science, Calgary Health Region, Foothills Hospital, Calgary, Alberta, Canada

    L. Brent Mitchell

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  1. L. Brent Mitchell
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Mitchell, L.B. The Role of the Transvenous Catheter Electrophysiologic Study in the Evaluation and Management of Ventricular Tachyarrhythmias Associated with Ischemic Heart Disease. Card Electrophysiol Rev 6, 458–462 (2002). https://doi.org/10.1023/A:1021152812529

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  • DOI: https://doi.org/10.1023/A:1021152812529

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