We know that induction of ventricular fibrillation in EP study makes result of that study non-specific. What do you think/know about ventricular flutter? We have patient with ventricular flutter induced repeatably - first time it stopped spontaneously, second time it degenerated to VF. Is it positive EP test or not. Should we place an ICD or not. Echocardiography is completely normal.
All depends on the context. What was the reason for the EP study? Syncope? How many prematures were used to induce the ventricular flutter and how closely where they coupled? Closely coupled or coupling interval under 200 ms or multiple premature beats make it less specific finding.
There were 3 premature beats, with closest coupling interval of 210ms. Without isoproterenol. The reason was non sustained VT in repeat holter monitorings. We are waiting for MRI now.
Well, that seems to be a reasonable induction protocol hence my believe that this is a specific finding. The Holter monitoring had to be prompted by some symptoms. If all adds together this may a valid indication of ICD implant particularly if there is structural heart diseases. NSVT in a setting of normal EF and normal structurally heart rarely renders patients high risk for SCD.
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