Circulation, Vol 57, 431-440, Copyright © 1978 by American Heart Association
ME Josephson, LN Horowitz, A Farshidi and JA Kastor
The mechanism of recurrent sustained ventricular tachycardia (VT) was
evaluated in 21 patients. Re-entry as the mechanism for VT was suggested by
a) the reproducible initiation (19) and termination (15) of the arrhythmia
by programmed stimulation. The rate, ventricle of origin, and stimulation
site determined the method of termination. One VPD was usually required
with VT rates less than 175/min and/or ventricle of origin ipsilateral to
the stimulation site, while two VPDs were usually required for VT with
faster rates originating in a contralateral ventricle. The proximal
His-Purkinje system (HPS) was not required for initiation or maintenance of
VT. Evidence localizing the site of re-entry to a small portion of the
ventricles included: a) ventricular capture by ventricular premature
depolarizations (VPDs) or pacing (VP) without terminating VT (5), b) sinus
capture following VPDs and/or supraventricular fusions without terminating
VT (12), and c) atrial pacing normalizing the QRS and H-V intervals without
terminating VT (5).
ARTICLES
Recurrent sustained ventricular tachycardia. 1. Mechanisms
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