Abstract 19766: The Role of Myocardial Perfusion Imaging in Evaluating Patients Presenting With Ventricular Tachycardia and Implantable Cardioverter Defibrillator Therapy
Introduction: Myocardial ischemia and scar burden are generally accepted to be substrate for cardiac arrhythmias. Despite this, the role of myocardial perfusion imaging in the evaluation of ventricular tachycardia (VT) is not clearly defined.
Methods: We retrospectively identified patients with sustained VT from 2004-2014, requiring ICD therapies (ATP or shock) who had undergone SPECT myocardial perfusion imaging within 90 days of their VT event. Patients were subdivided based on the etiology of their cardiomyopathy (ischemic or non-ischemic). We evaluated patient characteristics, perfusion imaging results, subsequent coronary angiography and revascularization in this cohort.
Results: A total of 70 patients were identified, 48 (68.6%) with ischemic and 22 (31.4%) with non-ischemic cardiomyopathy. Patients with ischemic cardiomyopathy had larger and more severe perfusion defects both at stress (SSS 16.5 vs 6.6, p<0.0001) and at rest (SRS 14.0 vs 5.7 p=0.0004), as well as greater amount of ischemia (SDS 2.5 vs 0.6, p=0.08). Subsequently, 7 patients (10%) underwent angiography and only 2 (2.9%) were revascularized. Of the 2 patients in the non-ischemic group who underwent angiography, neither had obstructive disease.
Conclusions: This data suggests that routine myocardial perfusion imaging following episodes of VT requiring ICD therapy (ATP or shock) provides little additional yield in patients beyond the original categorization of myopathy cause, especially in non-ischemic cardiomyopathies. Importantly, this data does not apply to patients with clinical symptoms or evidence for ischemia who would benefit from proceeding directly to angiography.
- Ventricular tachycardia
- Myocardial perfusion
- Noninvasive cardiac imaging
- Implantable cardiovertor defibrillator
Author Disclosures: J.W. Harrison: None. A. Manola: None. N. Kowlgi: None. W. Duvall: None. D. Giedrimiene: None. J. Kluger: None.
- © 2016 by American Heart Association, Inc.