Circulation, Vol 74, 722-730, Copyright © 1986 by American Heart Association
JM Almendral, NJ Stamato, ME Rosenthal, FE Marchlinski, JM Miller and ME Josephson
We analyzed the resetting response (a noncompensatory pause after
electrical stimulation) during 37 hemodynamically tolerated ventricular
tachycardias (VTs) induced by programmed electrical stimulation in 32
patients with chronic coronary artery disease. The mean cycle length of VT
was 369 +/- 59 msec. Single extrastimuli were delivered at the right
ventricular apex during all 37 VTs, and double extrastimuli were delivered
at the same site during 23 VTs. The resetting response pattern was
considered increasing, decreasing, or flat if the return cycle increased,
decreased, or remained constant in response to progressively shorter
coupling intervals of the extrastimuli. Ten VTs had an increasing pattern
and nine a flat pattern. In 11 VTs the pattern was mixed (flat at longer
coupling intervals and increasing at shorter ones), and in the remaining
seven the pattern could not be defined. No VT had a decreasing pattern. The
mean duration of the resetting interval (range of coupling intervals
resulting in resetting) was 66 +/- 45 msec, or 17% of the cycle length of
VT. VT with a mixed pattern had longer resetting intervals than VT with an
increasing pattern (102 +/- 34 vs 64 +/- 40 msec; p less than .035);
however, cycle lengths of VT were similar (370 +/- 58 vs 386 +/- 86, p =
NS). An excellent correlation was observed between the shortest return
cycles in response to single and double extrastimuli (r = .99), with a mean
difference of 5 msec. The cycle length of VT exceeded the return cycle
(measured to the QRS onset) during 15 VTs (41%).(ABSTRACT TRUNCATED AT 250
WORDS)
ARTICLES
Resetting response patterns during sustained ventricular tachycardia: relationship to the excitable gap
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