Abstract 20258: Low Yield of Routine Coronary Angiography in the Setting of Monomorphic VT
Introduction: Monomorphic Ventricular Tachycardia (MVT) in patients with CAD is often a reentrant rhythm related to a healed myocardial infarction. Coronary ischemia is not a well-described cause of MVT. However, the routine use of coronary angiography to evaluate and treat obstructive CAD in patients with MVT is recommended by prior and current guidelines and used routinely in practice.
Hypothesis: The routine use of coronary angiography in the evaluation of patients with MVT is unlikely to discover new obstructive CAD.
Methods: A retrospective analysis of patients at a single center undergoing cardiac catheterization for MVT during a 5-year period from 2010 to 2015 was performed. Baseline characteristics, coronary angiography findings, PCI and any documentation of recurrent MVT were collected.
Results: We identified 123 patients that underwent cardiac catheterization for evaluation of MVT. The average age of patients in the study was 64 years (+/-12.5 years). 45% of patients had a known history of CAD, 26% had previously underwent coronary artery bypass grafting, and 32% had a previously implanted ICD. The average ejection fraction was 46% (+/-15%). 40% of patients in the study had no structural heart disease, 37% were previously diagnosed with ischemic cardiomyopathy, 8% with non-ischemic cardiomyopathy and 12% with other forms of cardiomyopathy. 55 patients (45%) had non-sustained MVT (NSVT), 53 patients (54%) had sustained MVT or ICD therapy, 2 patients (1.6%) had MVT with cardiac arrest. Only 11 patients (9%) underwent PCI. Eight of these patients had recurrent MVT. Of 3 patients without known recurrence (2.4%), 1 is on amiodarone and the other two patients initially presented with asymptomatic NSVT. No patient that underwent PCI had angiographic findings consistent with plaque rupture.
Conclusion: Few patients had CAD that prompted PCI, and there appears to be little or no benefit from PCI in the treatment of MVT. Coronary angiography may not be warranted in the routine evaluation of patients with MVT.
Author Disclosures: A. Trivedi: None. N. Verma: None. R. Arora: None. B.P. Knight: None. S.S. Kim: None. A.C. Lin: None. R.S. Passman: None. A.P. Chicos: None.
- © 2016 by American Heart Association, Inc.