Circulation, Vol 72, 1293-1307, Copyright © 1985 by American Heart Association
K Okumura, RW Henthorn, AE Epstein, VJ Plumb and AL Waldo
Transient entrainment of circus-movement tachycardia utilizing an
atrioventricular (AV) bypass pathway was studied in 13 patients (nine with
the orthodromic form, two with the antidromic form, and two with both the
orthodromic and antidromic forms). All patients had a left- sided AV bypass
pathway. Pacing at selected rates faster than the spontaneous rate was
performed during the tachycardia at a site proximal or distal to the AV
node, an area of slow conduction within the reentry loop. Rapid pacing from
a site proximal to the AV node (from the right atrium during the
orthodromic form of the arrhythmia or the right ventricle during the
antidromic form of the arrhythmia) always demonstrated at least one of the
three entrainment criteria: constant fusion beats except for the last
captured beat, which was entrained but not fused (first criterion);
progressive fusion (second criterion); localized conduction block to a
site(s) for 1 paced beat associated with interruption of the tachycardia
followed by activation of that site(s) by the next paced beat from a
different direction and with a shorter conduction time (third criterion).
In contrast, rapid pacing from a site distal to the AV node (from the right
ventricle during the orthodromic form of the arrhythmia, or the right
atrium during the antidromic form of the arrhythmia) transiently entrained
the tachycardia, but never demonstrated any entrainment criteria because
the antidromic wave front from the pacing impulse always blocked in the AV
node (concealed entrainment). We conclude that the location of the pacing
site relative to the components of a reentry loop is critical to the
demonstration of the criteria of transient entrainment; i.e., if it is
proximal to an area of slow conduction and/or unidirectional block within a
reentry loop, transient entrainment should be demonstrable, but if it is
distal, it will not be demonstrable.
ARTICLES
Further observations on transient entrainment: importance of pacing site and properties of the components of the reentry circuit
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