Effect of pacing drive cycle length on induction of sustained monomorphic ventricular tachycardia

To assess the effect of pacing drive cycle length on induction of sustained monomorphic ventricular tachycardia, 40 patients were prospectively studied in the drug-free state. Ventricular extrastimuli were sequentially delivered at the same coupling interval at each of three drive cycle lengths (600, 500, and 400 ms) before the coupling interval was shortened and the process repeated. This protocol was continued until sustained monomorphic ventricular tachycardia was induced at all three drive cycle lengths or until pacing was completed through three extrastimuli. Of the 27 patients in whom sustained monomorphic ventricular tachycardia was induced, tachycardia was induced at all 3 drive cycle lengths in 12 (44%), only 2 drive cycle lengths in 11 (41%), and only 1 drive cycle length in 4 (15%) patients. Although the yield of inducible ventricular tachycardia increased with each additional extrastimulus, this yield increased even further with the use of multiple drive cycle lengths. In 10 of 11 patients, failure to induce ventricular tachycardia at any drive cycle length was not due to failure to achieve at that drive cycle length the critical extrastimulus coupling interval required to induce tachycardia at other drive cycle lengths. Induction of sustained monomorphic ventricular tachycardia is often drive cycle length specific, and failure to induce tachycardia cannot be explained by failure to achieve critically short coupling intervals. Pacing at multiple drive cycle lengths increases the yield of induced ventricular tachycardia.