Reply to the letter by Lin et al “Longitudinal mechanics of the periinfarct zone and ventricular tachycardia inducibility in patients with chronic ischemic cardiomyopathy” To the Editor: We thank Lin et al for their interest in our recent study. 1 We would like to highlight that QRS duration was a univariable predictor of inducibility but not an indepen- dent predictor on the multivariable analysis. Furthermore, the patients included had ischemic cardiomyopathy and often experienced multiple myocardial infarctions. There- fore, analysis of location of previous myocardial infarction in relation to the current results is difficult. In contrast, the time elapsed since the last myocardial infarction could be a relevant variable with an influence on the arrhythmo- genic substrate. However, similarly to the QRS duration, the time elapsed since the last myocardial infarction was only predictive on the univariable (and not on the multivariable) analysis. Finally, Lin et al suggested comparing the periinfarct zone longitudinal mechanics in patients with a left ventricular ejection fraction ≤30% versus patients with left ventricular ejection fraction N30% in an attempt to better stratify the risk of ventricular arrhythmias. We did not find significant differences in left ventricular ejection fraction between inducible and noninducible patients. Furthermore, no statistical differences in inducibility of monomorphic ventricular tachycardia (P = .46) and longitudinal systolic strain of the periinfarct zone (P = .15) were observed when the patient population was dichotomized according to left ventricular ejection fraction ≤30% or N30%. This may be explained by the small number of patients included in the present study as compared to the MUSTT trial, for example. 2 Lin et al mentioned also the VTACH trial. 3 In that trial, Kuck et al 3 showed that prophylactic ventricular tachycardia ablation before cardioverter-defibrillator implantation prolongs time to recurrence of ventricular tachycardia, in particular, in patients with left ventricular ejection fraction N30%. In the VTACH trial, the study population consisted of patients with documented stable ventricular tachycardia, whereas in our patient population, sustained ventricular tachycardia was documented by an electro- physiologic study. Indeed, in the present study, only 54% of the patients were classified as inducible, whereas in the VTACH trial, monomorphic ventricular tachycardia was induced in 88% of the patients. Am Heart J 2011;161:e19. 0002-8703/$ - see front matter doi:10.1016/j.ahj.2011.01.014 Matteo Bertini, MD, PhD Department of Cardiology Leiden University Medical Center Leiden, The Netherlands University of Ferrara Ferrara and Fundation S. Maugeri Centro di Lumezzane Brescia, Italy Arnold C.T. Ng, MBBS Victoria Delgado, MD Jeroen J. Bax, MD, PhD Department of Cardiology Leiden University Medical Center Leiden, The Netherlands E-mail: j.j.bax@lumc.nl References 1. Bertini M, Ng AC, Borleffs CJ, et al. Longitudinal mechanics of the periinfarct zone and ventricular tachycardia inducibility in patients with chronic ischemic cardiomyopathy. Am Heart J 2010;160: 729-36. 2. Buxton AE, Lee KL, Hafley GE, et al. Relation of ejection fraction and inducible ventricular tachycardia to mode of death in patients with coronary artery disease: an analysis of patients enrolled in the multicenter unsustained tachycardia trial. Circulation 2002;106: 2466-72. 3. Kuck KH, Schaumann A, Eckardt L, et al. Catheter ablation of stable ventricular tachycardia before defibrillator implantation in patients with coronary heart disease (VTACH): a multicentre randomised controlled trial. Lancet 2010;375:31-40.