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Programmed electrical stimulation protocols: variations on a theme.

J D Fisher1, S G Kim, K J Ferrick

  • 1Department of Medicine, Montefiore Medical Center, Bronx, New York 10467.

Pacing and Clinical Electrophysiology : PACE
|November 1, 1992
PubMed
Summary
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Programmed electrical stimulation (PES) protocols were optimized to improve the yield ratio of inducing clinical ventricular tachycardia (VT) in patients. Sinus rhythm with triple extrastimuli and lower rate pacing with triple extrastimuli showed the best results.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Device Testing

Background:

  • Programmed electrical stimulation (PES) is crucial for diagnosing ventricular arrhythmias.
  • Optimizing PES protocols is essential to enhance the diagnostic yield ratio, distinguishing true positives from false positives.

Purpose of the Study:

  • To determine the optimal programmed electrical stimulation (PES) variables for maximizing the yield ratio of clinically relevant ventricular tachycardia (VT) induction.
  • To compare the efficacy of different PES sequences and pacing parameters in various patient groups.

Main Methods:

  • A prospective study involving 772 patients, utilizing sequential single, double, and triple extrastimuli at different ventricular sites (RV apex, outflow tract) and conditions (sinus rhythm, paced rates, isoproterenol infusion).

Related Experiment Videos

  • A secondary protocol in 61 patients with inducible VT ensured completion of all steps for accurate yield ratio assessment.
  • The protocol adhered to NASPE standards for VT induction in patients with coronary artery disease and VT history.

    • Main Results:

    • The protocol successfully induced monomorphic VT in patients with coronary artery disease and VT history, while failing in control patients.
    • Optimal yield ratios and highest likelihood of inducing clinical tachycardia were observed with sinus rhythm and triple extrastimuli, and lower rate pacing with triple extrastimuli.
    • Faster pacing rates with triple extrastimuli were highly inductive of arrhythmias but yielded a lower ratio due to increased nonclinical arrhythmias.

    Conclusions:

    • Specific programmed electrical stimulation (PES) sequences, particularly sinus rhythm and lower rate pacing with triple extrastimuli, significantly improve the yield ratio for inducing clinical ventricular tachycardia (VT).
    • Careful selection of PES variables is critical for accurate diagnosis and effective risk stratification in patients with suspected ventricular arrhythmias.