Hemodynamically Tolerated Ventricular Tachycardia With Mildly Impaired Ejection Fraction: Do These Patients Have VT/VF Recurrence and ICD Therapies?

Background: Patients with hemodynamically tolerated ventricular tachycardia (VT) and minimally reduced left ventricular ejection frac-tion (LVEF) remain a group that presents a prognostic and therapeutic dilemma.Methods: We studied patients from our implanted cardioverter-defibrillator (ICD) database who received ICDs for hemodynamically tolerated VT and mildly reduced LVEF (36%-49%) at time of implant between May 2015 and December 2019. Time to appropriate ICD therapy was assessed. Clinical features associated with recurrent VT/ ventricular fibrillation (VF) with ICD therapies were explored using bi-nary logistic regression.Results: Among 2037 ICDs placed between May 2015 and December 2019, 64 subjects met the inclusion criteria. The mean age of the study group was 68 +/- 12 years, and 58 (90.6%) subjects were male. Average ejection fraction was 40% +/- 4.4 (range 36%-49%). Twenty-two (34%) subjects received antitachycardia pacing (ATP) for VT at 229 +/- 265 days after ICD placement. Fifteen (23%) subjects received appropriate ICD shocks 305 +/- 321 days after implant. The rate of recurrent VT/VF among the 37 patients with ICD therapy was 195 +/- 39 beats per minute (bpm). This was significantly more rapid than initial presenting VT rates before ICD placement (183 +/- 27 bpm) (P = 0.048). Multivariate analysis showed no factors independently asso-ciated with recurrent VT/VF.Conclusions: Patients with mildly impaired LV function and hemody-namically tolerated VT receive appropriate ICD therapies over the 3 years following implant. This patient group warrants further investi-gation, as their recurrent VT/VF rates can be much more rapid, and 23% go on to receive appropriate ICD shocks.

Automated summary

Patients with mildly impaired LV function and hemodynamically tolerated VT receive appropriate ICD therapies over the 3 years following implant. Recurrent VT/VF rates can be much more rapid after ICD placement, with 23% of patients going on to receive appropriate ICD shocks.