Advertisement

Clinical and electrophysiologic findings in patients with repetitive monomorphic ventricular tachycardia and otherwise normal electrocardiogram

  • G.Thomas Rahilly
    Footnotes
    Affiliations
    From the Krannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA

    From the Veterans Administration Hospital, Indianapolis, Indiana, USA
    Search for articles by this author
  • Eric N. Prystowsky
    Affiliations
    From the Krannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA

    From the Veterans Administration Hospital, Indianapolis, Indiana, USA
    Search for articles by this author
  • Douglas P. Zipes
    Affiliations
    From the Krannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA

    From the Veterans Administration Hospital, Indianapolis, Indiana, USA
    Search for articles by this author
  • Gerald V. Naccarelli
    Affiliations
    From the Krannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA

    From the Veterans Administration Hospital, Indianapolis, Indiana, USA
    Search for articles by this author
  • Warren M. Jackman
    Affiliations
    From the Krannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA

    From the Veterans Administration Hospital, Indianapolis, Indiana, USA
    Search for articles by this author
  • James J. Heger
    Correspondence
    Address for reprints: James J. Heger, MD, Indiana University School of Medicine, Krannert Institute of Cardiology, 1001 West 10th Street, Indianapolis, Indiana 46202.
    Affiliations
    From the Krannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA

    From the Veterans Administration Hospital, Indianapolis, Indiana, USA
    Search for articles by this author
  • Author Footnotes
    ∗ The authors express their sincere regret at the recent untimely loss of their colleague (and co-author), G. Thomas Rahilly, MD.
    † Dr. Rahilly was supported in part by a grant from the John Sable Heart Fund, Rochester, New York.
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Natural history, structural substrate, electrocardiographic and electrophysiologic characteristics and therapy were evaluated in 18 patients who demonstrated repetitive ventricular tachycardia, defined as repeated episodes of ventricular tachycardia that had a uniform QRS configuration and normal sinus-conducted QRS complexes between the episodes of tachycardia. The patients were young (mean age 37 years) and frequently had a long history of arrhythmia before this evaluation; only two patients had a history of syncope and six were completely asymptomatic. Fourteen patients had no evidence of underlying structural heart disease, three had mitral valve prolapse and one had congestive cardiomyopathy. Episodes of ventricular tachycardia tended to occur in clusters over a 24 hour electrocardiographic recording period.
      Repetitive ventricular tachycardia was induced in two of nine patients by programmed electrical stimulation, and in seven patients incremental atrial and ventricular pacing suppressed spontaneous arrhythmia. In the one patient whose tachycardia was induced by incremental ventricular pacing there was an inverse relation between pacing cycle length and the interval from the last paced complex to the first complex of ventricular tachycardia, indicating there was overdrive suppression.
      At a follow-up time of 0.5 to 8 years no patient had died or had worsening of symptoms. Encainide completely eliminated episodes of ventricular tachycardia during acute treatment in five of six patients tested. Seven patients received no antiarrhythmic therapy and the arrhythmia appeared to have spontaneously resolved in four of these patients. Repetitive ventricular tachycardia appears to have distinct clinical and electrophysiologic characteristics. In this series the arrhythmia had a good prognosis and often required no treatment. The electrophysiologic features are consistent with a mechanism of automaticity.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Gallavardin L
        Extra-systolie ventriculaire a paroxysmes tachycardiques prolonges.
        Arch Mal Coeur. 1922; 15: 298-306
        • Gallavardin L
        • Veil P
        Extra-systolie ventriculaire avec salves tachycardiques et accidents vertigineux.
        Arch Mal Coeur. 1929; 22: 25-29
        • Gallavardin L
        • Veil P
        Deux nouveaux cas d'extrasystolie—ventriculaire avec salves tachycardiques.
        Arch Mal Coeur. 1929; 22: 738-741
        • Wilson RN
        • Wishart SW
        • Maclead AG
        • Barker PS
        A clinical type of paroxysmal tachycardia of ventricular origin in which paroxysms are induced by exertion.
        Am Heart J. 1932; 8: 155-169
        • Dimond EG
        • Hayes WL
        Benign paroxysmal ventricular tachycardia: report of a case.
        Ann Intern Med. 1960; 53: 1255-1260
        • Campbell M
        • Elliott GA
        Paroxysmal tachycardia: aetiology and prognosis of one hundred cases.
        Br Heart J. 1939; 1: 123-1260
        • Froment R
        • Gallavardin L
        • Cahen P
        Paroxysmal ventricular tachycardia: a clinical classification.
        Br Heart J. 1953; 15: 172-178
        • Parkinson J
        • Papp C
        Repetitive paroxysmal tachycardia.
        Br Heart. 1947; 9: 241-262
        • Lesch M
        • Lewis E
        • Humphries JO
        • Ross R
        Paroxysmal ventricular tachycardia in the absence of organic heart disease.
        Ann Intern Med. 1967; 66: 950-960
        • Steffens TG
        • Pierce PL
        • Zegerius RJ
        Multiple ventricular premature beats in five adolescents.
        Eur J Cardiol. 1978; 8: 177-184
        • Rally C
        • Walters M
        Paroxysmal ventricular tachycardia without evident heart disease.
        Can Med Assoc J. 1962; 86: 268-273
        • Maddox K
        Intermittent ventricular tachycardia in youth. Report of a case with fatal termination (abstr).
        Am Heart J. 1947; 33: 739-740
        • Chapman JH
        • Schank JP
        • Crampton RS
        Idiopathic ventricular tachycardia: an intracardiac electrical, hemodynamic and angiographic assessment of six patients.
        Am J Med. 1975; 59: 470-480
        • Denes P
        • Wu D
        • Dhingra RC
        • et al.
        Electrophysiological studies in patients with chronic recurrent ventricular tachycardia.
        Circulation. 1976; 54: 229-236
        • Pederson DH
        • Zipes DP
        • Foster PR
        • Troup PJ
        Ventricular tachycardia and ventricular fibrillation in a young population.
        Circulation. 1979; 60: 988-997
        • Ambrust CA
        • Levine SA
        Paroxysmal ventricular tachycardia: a study of one-hundred and seven cases.
        Circulation. 1950; 1: 28-40
        • James TN
        • Marilley RJ
        • Marriott HJL
        De subitaneis mortibus XI. Young girl with palpitations.
        Circulation. 1975; 51: 743-748
        • Cranefield PF
        Action potentials, afterpotentials, and arrhythmias.
        Circ Res. 1977; 41: 415-423
        • Zipes DP
        • Foster PR
        • Troup PJ
        • Pederson DH
        Atrial induction of ventricular tachycardia: reentry versus triggered automaticity.
        Am J Cardiol. 1979; 44: 1-8
        • Ferrier GR
        • Saunders JH
        • Mendez C
        A cellular mechanism for the generation of ventricular arrhythmias by acetylstrophanthidin.
        Circ Res. 1973; 32: 600-609
        • Rosen MR
        • Fisch C
        • Hoffman BF
        • Danilo P
        • Lovelace DE
        • Knoebel SB
        Can accelerated atrioventricular junctional escape rhythms be explained by delayed afterdepolarization?.
        Am J Cardiol. 1980; 45: 1272-1284
        • Zipes DP
        • Arbel E
        • Knope RF
        • Moe GK
        Accelerated cardiac escape rhythms caused by ouabain intoxication.
        Am J Cardiol. 1974; 33: 248-253
        • Wellens HJJ
        • Duren DR
        • Lie KI
        Observations on mechanisms of ventricular tachycardia in man.
        Circulation. 1976; 54: 237-244
        • Josephson ME
        • Horowitz LN
        • Farshidi A
        • Kastor JA
        Recurrent sustained ventricular tachycardia 1. Mechanisms.
        Circulation. 1978; 57: 431-440
        • Rosen MR
        • Reder RF
        Does triggered activity have a role in the genesis of cardiac arrhythmias?.
        Ann Intern Med. 1981; 94: 794-801
        • Morganroth J
        • Michelson EL
        • Horowitz LN
        • Josephson ME
        • Pearlman AS
        • Dunkman WB
        Limitations of routine long-term electrocardiographic monitoring to assess ventricular ectopic frequency.
        Circulation. 1978; 58: 408-414
        • Roden DM
        • Reele SB
        • Higgins SB
        Total suppression of ventricular arrhythmias by encainide: pharmacokinetic and electrocardiographic characteristics.
        N Engl J Med. 1980; 302: 877-882