Relation of induced to spontaneous ventricular tachycardia from analysis of stored far-field implantable defibrillator electrograms

Abstract

Predischarge testing of implantable cardioverter-defibrillators is often used to tailor antitachycardia pacing algorithms based on the response of induced ventricular tachycardia (VT) to pacing. Despite this practice, little is known about the relation between VT induced at predischarge study and VT that occurs spontaneously. To clarify this relation, we identified 19 patients with VT induced at predischarge study and compared the characteristics of the induced VT with the first episode of spontaneous VT. VT morphology, tachycardia cycle length, and response to antitachycardia pacing were measured from far-field electrograms stored by the implantable cardioverter-defibrillator. All subjects had coronary artery disease and previous myocardial infarction. The mean time from baseline study until a spontaneous VT episode was 162 ± 121 days. Analysis of far-field electrograms revealed that spontaneous VT was morphologically different from predischarge-induced VT in 13 of 19 cases (68%). The cycle length of induced VT was significantly shorter than spontaneous VT when VT morphologies were different but not when spontaneous and induced VT had an identical morphology. Antitachycardia pacing was effective in terminating 18 of 19 (95%) induced VTs and 14 of 18 (78%) spontaneous VTs. Antitachycardia pacing was effective in terminating 9 of 12 episodes of morphologically different spontaneous VTs and 5 of 6 episodes of morphologically identical spontaneous VTs (p = NS). Thus, the characteristics of VT induced at predischarge study correlate poorly with those of subsequent spontaneous VT episodes due to the induction of faster “nonclinical” VTs at predischarge testing. This may limit the applicability of predischarge testing in tailoring antitachycardia pacing algorithms.