Effect of the intertrain pause on the ventricular effective refractory period measured by the extrastimulus technique

This study determined the effect of the duration of the intertrain pause on the ventricular effective refractory period (VERP) measured by the extrastimulus technique using conventional eight-beat basic drive trains. In 50 subjects, the VERP was measured using a basic drive train cycle length of 500 msec, 2-msec steps in the extrastimulus coupling interval, and intertrain pauses of 0, 1, 4, 8, 20, 40, 60, or 180 seconds. The VERP increased significantly with each stepwise increment in the intertrain pause up to 20 seconds, then reached a plateau. The VERP measured with an intertrain pause of 20 seconds was a mean of 13 msec longer than when measured with a conventional 4-second pause. The results of this study demonstrate a direct relationship between the VERP and the duration of the pause separating the eight-beat basic drive trains used to measure the VERP. When the cycle length of the basic drive train is 500 msec, the VERP lengthens as the duration of the intertrain pause increases from 1 to 20 seconds, demonstrating that the basic drive trains exert a cumulative effect on the VERP when the intertrain pause is shorter than 20 seconds. A cumulative effect of the basic drive trains on the VERP is lost when the intertrain pause is 20 seconds or more.