Circulation, Vol 69, 532-540, Copyright © 1984 by American Heart Association
AE Buxton, HL Waxman, FE Marchlinski, WJ Untereker, LE Waspe and ME Josephson
Electrophysiologic studies were performed in 172 consecutive patients for
evaluation of documented sustained ventricular tachyarrhythmias. One
hundred thirteen patients presented with sustained ventricular tachycardia
that was hemodynamically stable, and 59 patients presented with cardiac
arrest. Seventy-one patients without previously documented or suspected
ventricular arrhythmias were also studied to determine the specificity of
our electrophysiologic study protocol. The stimulation protocol included
single, double, and triple right ventricular extrastimuli and rapid
ventricular pacing at multiple cycle lengths performed at one or more right
ventricular sites. Stimulation was performed at one or more left
ventricular sites in patients with documented spontaneous arrhythmias when
right ventricular programmed stimulation failed to induce sustained
ventricular tachycardia. Ventricular tachyarrhythmias were induced in 110
(97%) of the patients who presented with sustained ventricular tachycardia,
in 48 (81%) of the patients who presented with cardiac arrest, and in 28
(40%) of the patients without documented spontaneous arrhythmias. Right
ventricular triple extrastimuli induced tachycardia in 22% of patients who
presented with sustained ventricular tachycardia vs 46% of those who
presented with cardiac arrest (p less than .001). Left ventricular
stimulation was required for tachycardia induction in 3% of patients with
stable tachycardia vs 19% of those with cardiac arrest (p less than .01).
Triple extrastimuli induced 57% of tachycardias in the 28 patients without
spontaneous arrhythmias, and virtually all of these tachycardias were
polymorphic and nonsustained. The cycle lengths of tachycardias induced in
each group by double and triple extrastimuli were similar, but the
tachycardias induced in patients with cardiac arrest were significantly
faster than those induced in the ventricular tachycardia group (mean cycle
length 218 vs 291 msec, p less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Role of triple extrastimuli during electrophysiologic study of patients with documented sustained ventricular tachyarrhythmias
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