Abstract 17286: Does Monomorphic Ventricular Tachycardia Justify Coronary Angiography?
INTRODUCTION Current guidelines recommend the routine use of coronary angiography to evaluate polymorphic ventricular arrhythmias and ventricular fibrillation (Class I, Level of Evidence C). Earlier guidelines had recommended coronary angiography for sustained, monomorphic ventricular tachycardia (MMVT), but there are only isolated case reports that draw a link between MMVT and myocardial ischemia.
METHODS Patients were identified by cross-referencing the International Classification of Disease (ICD-9) code for ventricular tachycardia or ventricular fibrillation and Current Procedural Terminology (CPT) codes for left heart catheterization for a single admission at Cooper University Hospital between January 2010 and 2011. Those charts with telemetry, 12-lead electrocardiography, and/or intracardiac electrograms confirming MMVT were included.
RESULTS Fifty-seven patients were identified, of which 66.6% were men and the average age was 66.3 years [38-86]. Twenty-five patients (43.9%) had either normal coronary arteries or non-obstructive coronary artery disease (CAD). Twenty-five patients (43.9%) had known chronic CAD which did not require intervention. Three patients (5.3%) had newly diagnosed obstructive CAD, but did not undergo revascularization because of branch vessel disease (1), lack of demonstrable viability (1), or severe co-morbidities (1). Four patients (7.1%) underwent percutaneous (3) or surgical (1) revascularization. Follow up was available for 3 of the 4 patients, of which only 1 had complete resolution of ventricular arrhythmias with revascularization not requiring membrane active anti-arrhythmic therapy or radiofrequency ablation. One patient required amiodarone, and the other required radiofrequency ablation.
DISCUSSION The vast majority patients referred for coronary angiography to evaluate monomorphic ventricular arrhythmias do not require revascularization. In the minority of patients who do, it is not clear that revascularization reduces the burden of monomorphic ventricular tachycardias. The yield of coronary angiography in this setting is low and should be considered on a case-by-case basis.
- © 2012 by American Heart Association, Inc.