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Analysis of programmed stimulation methods in the evaluation of ventricular arrhythmias in patients 20 years old and younger

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      Abstract

      The purpose of this study was to systematically evaluate programmed ventricular stimulation in patients <21 years of age undergoing electrophysiologic testing. A standardized protocol was applied in 55 consecutive patients (mean age 14 years) with the following clinical presentations: sustained ventricular tachycardia (VT) (n = 17); ventricular fibrillation (VF) (n = 7); syncope with heart disease (n = 10); nonsustained VT (n = 6); and syncope with an ostensibly normal heart (n = 15). The stimulation protocol consisted of 1 and 2 ventricular extrastimuli during sinus rhythm, followed by 1 to 4 (S2 S3, S4, S5) extrastimuli during pacing at 2 ventricular sites. Of the 17 patients with sustained VT, 12 had induction of the arrhythmia (sensitivity = 71%). Overall, 18 of 55 patients had inducible sustained VT, with this response significantly enhanced by use of S4 or S5 protocols (p = 0.02). Although no syncope patient with an ostensibly normal heart had inducible sustained VT, 7 had polymorphic nonsustained VT in response to ventricular stimulation. The mean number of extrastimuli preceding the induction of nonsustained or sustained VT or VF did not differ. The induction of VF in 5 cases during this study was preceded in each case by extrastimuli intervals ≤190 ms. Thus, data indicate that aggressive stimulation protocols appear to be required for induction of sustained VT in most young patients, nonsustained polymorphic VT as a response to aggressive programmed stimulation is of uncertain significance, and that coupling intervals ≤190 ms may correlate with the induction of VF.
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      References

        • Wellens HJ
        • Schuilenburg RM
        • Durrer D
        Electrical stimulation of the heart in patients with ventricular tachycardia.
        Circulation. 1972; 46: 216-226
        • Wellens HJJ
        • Lie KI
        • Durrer D
        Further observations on ventricular tachycardia as studied by electrical stimulation of the heart: chronic recurrent ventricular tachycardia and ventricular tachycardia during acute myocardial infarction.
        Circulation. 1974; 49: 647-653
        • Naccarelli GV
        • Prystowsky EN
        • Jackman WM
        • Heger JJ
        • Rahilly GT
        • Zipes DP
        Role of electrophysiologic testing in managing patients who have ventricular tachycardia unrelated to coronary artery disease.
        Am J Cardiol. 1982; 50: 165-171
        • Poll DS
        • Marchlinski FE
        • Buxton AE
        • Doherty JU
        • Waxman HL
        • Josephson ME
        Sustained ventricular tachycardia in patients with idiopathic dilated cardiomyopathy: electrophysiologic testing and lack of response to antiarrhythmic drug therapy.
        Circulation. 1984; 70: 451-456
        • Bhandari AK
        • Shapiro W
        • Morady F
        • Shen EN
        • Mason J
        • Scheinman MM
        Electrophysiologic testing in patients with the long QT syndrome.
        Circulation. 1985; 71: 63-71
        • Morady F
        • Shen E
        • Bhartdari A
        • Schwartz A
        • Scheinman MM
        Programmed ventricular stimulation in mitral valve prolapse: analysis of 36 patients.
        Am J Cardiol. 1984; 53: 135-138
        • Benson DW
        • Benditt DG
        • Anderson RW
        • Dunnigan A
        • Pritzker MR
        • Kulik TJ
        • Zavoral JH
        Cardiac arrest in young, ostensibly healthy patients: clinical, hemodynamic, and electrophysiologic findings.
        Am J Cardiol. 1983; 52: 65-69
        • Livelli FD
        • Bigger JT
        • Reiffel JA
        • Gang ES
        • Patton JN
        • Noethling PM
        • Rolnitzky LM
        • Gliklich JI
        Response to programmed ventricular stimulation: Sensitivity, specificity and relation to heart disease.
        Am J Cardiol. 1982; 50: 452-458
        • Doherty JU
        • Kienzle MG
        • Waxman HL
        • Buxton AE
        • Marchlinski FE
        • Josephson ME
        Programmed ventricular stimulation at a second right ventricular site: an analysis of 100 patients, with special reference to sensitivity, specificity and characteristics of patients with induced ventricular tachycardia.
        Am J Cardiol. 1983; 52: 1184-1189
        • Herre JM
        • Mann DE
        • Luck JC
        • Magro SA
        • Figali S
        • Breen T
        • Wyndham CRC
        Effect of increased current, multiple pacing sites and number of extrastimuli on induction of ventricular tachycardia.
        Am J Cardiol. 1986; 57: 102-107
        • Estes NAM
        • Garan H
        • McGovern B
        • Ruskin JN
        Influence of drive cycle length during programmed stimulation on induction of ventricular arrhythmias: Analysis of 403 patients.
        Am J Cardiol. 1986; 57: 108-112
        • Prystowsky EN
        • Miles WM
        • Evans JJ
        • Hubbard JE
        • Skale BT
        • Windle JR
        • Heger JJ
        • Zipes DP
        Induction of ventricular tachycardia during programmed electrical stimulation: analysis of pacing methods.
        Circulation. 1986; 73: II-32-II-38
        • Kudenchuk PJ
        • Kron J
        • Walance CG
        • Murphy ES
        • Morris CD
        • Griffith KK
        • McAnulty JH
        Reproducibility of arrhythmia induction with intracardiac electrophysiologic testing: patients with clinical sustained ventricular tachyarrhythmias.
        J Am Coll Cardiol. 1986; 7: 819-828
        • Josephson ME
        • Seides SF
        Clinical electrophysiology: techniques and interpretations.
        in: Lea & Febiger, Philadelphia1979: 247
        • Buxton AE
        • Waxman HL
        • Marchlinski FE
        • Josephson ME
        Electrophysiologic studies in nonsustained ventricular tachycardia: relation to underlying heart disease.
        Am J Cardiol. 1983; 52: 985-991
        • Lemery R
        • Brugada P
        • Della Bella P
        • Dugernier T
        • van den Dool A
        • Wellens HJJ
        Nonischemic ventricular tachycardia: clinical course and long-term follow-up in patients without clinically overt heart disease.
        Circulation. 1989; 79: 990-999
        • Waldo AL
        • Akhtar M
        • Brugada P
        • Henthorn RW
        • Scheinman MM
        • Ward DE
        • Wellens HJJ
        The minimally appropriate electrophysiologic study for the initial assessment of patients with documented sustained monomorphic ventricular tachycardia.
        J Am Coll Cardiol. 1985; 6: 1174-1177
        • Josephson ME
        • Horowitz LN
        • Farshidi A
        • Kastor JA
        Recurrent sustained ventricular tachycardia. 1. Mechanisms.
        Circulation. 1978; 57: 431-440
        • Josephson ME
        • Horowitz LN
        • Farshidi A
        • Spear JF
        • Kastor JA
        • Moore EN
        Recurrent sustained ventricular tachycardia. 2. Endocardial mapping.
        Circulation. 1978; 57: 440-447
        • Garson A
        • Smith RT
        • Moak JP
        • Kearney DL
        • Hawkins EP
        • Titus JL
        • Cooley DA
        • Ott DA
        Incessant ventricular tachycardia in infants: myocardial hamartomas and surgical cure.
        J Am Coll Cardiol. 1987; 10: 619-626
        • Deal BJ
        • Miller SM
        • Scagliotti D
        • Prechel D
        • Gallastegui JL
        • Hariman RJ
        Ventricular tachycardia in a young population without overt heart disease.
        Circulation. 1986; 73: 1111-1118
        • Vetter VL
        • Josephson ME
        • Horowitz LN
        Idiopathic recurrent sustained ventricular tachycardia in children and adolescents.
        Am J Cardiol. 1981; 47: 315-321
        • Garson A
        • Porter C-BJ
        • Gillette PC
        • McNamara DG
        Induction of ventricular tachycardia during electrophysiologic study after repair of tetralogy of Faliot.
        J Am Coll Cardiol. 1983; 1: 1493-1502
        • Deal BJ
        • Scagliotti D
        • Miller SM
        • Gallastegui JL
        • Hariman RJ
        • Levitsky S
        Electrophysiologic drug testing in symptomatic ventricular arrhythmias after repair of tetralogy of Fallot.
        Am J Cardiol. 1987; 49: 1380-1385
        • Chandar JS
        • Wolff GS
        • Garson A
        • Bell TJ
        • Beder SD
        • Bink-Boelkens M
        • Byrum CJ
        • Campbell RM
        • Deal BJ
        • Dick M
        • Flinn CJ
        • Gaum WE
        • Gillette PC
        • Hordof AJ
        • Kugler JD
        • Porter CJ
        • Walsh EP
        Ventricular arrhythmias in postoperative tetralogy of Faliot.
        Am J Cardiol. 1990; 65: 655-661
        • Morady F
        • DiCarlo LA
        • Baerman JM
        • de Buitleir M
        Comparison of coupling intervals that induce clinical and nonclinical forms of ventricular tachycardia during programmed stimulation.
        Am J Cardiol. 1986; 57: 1269-1273
        • Vandepol CJ
        • Farshidi A
        • Spielman SR
        • Greenspan AM
        • Horowitz LN
        • Josephson ME
        Incidence and clinical significance of induced ventricular tachycardia.
        Am J Cardiol. 1980; 45: 725-731
        • Wellens HJJ
        • Brugada P
        • Stevenson WG
        Programmed electrical stimulation of the heart in patients with life-threatening tachycardia arrhythmias: what is the significance of induced arrhythmias and what is the correct stimulation protocol?.
        Circulation. 1985; 72: 1-7
        • Wilson JH
        • Kyreakakis A
        • Maloney JD
        Ventricular fibrillation induced with programmed stimulation: clinical substrate and prognosis.
        J Electrophysiol. 1988; 2: 303-314
        • Brugada P
        • Abdollah H
        • Heddle B
        • Wellens HJJ
        Results of a ventricular stimulation protocol using a maximum of 4 premature stimuli in patients without documented or suspected ventricular arrhythmias.
        Am J Cardiol. 1983; 52: 1214-1218
        • Paul T
        • Marchal C
        • Garson A
        Ventricular couplets in the young: prognosis related to underlying substrate.
        Am Heart J. 1990; 119: 577-582