Effect of stimulation site on ventricular threshold in dogs with heart block

Ventricular pacing thresholds were measured in barbiturate-anesthetized dogs with complete heart block using an oscilloscope and current probe. All electrode and physiologic variables were carefully controlled in order to compare the effects of stimulus duration and site of ventricular threshold energy requirements. Left ventricular intramyocardial stimulation, at all stimulus durations under 5 msec., required less current and energy, and at all stimulus durations under 2 msec. less voltage, than either right ventricular endocardial or right ventricular intramyocardial stimulation. Chronaxy and polarization losses were lowest and impedance highest with left ventricular intramyocardial stimulation. The two right ventricular sites were almost equivalent electrically. Earlier studies which reported lower thresholds with endocardial stimulation than with intramyocardial stimulation were biased in favor of the endocardial site by lack of control of electrode variables including: material, configuration, cross-sectional area, and epicardial versus intramyocardial location.