Conduction through the reentrant circuit in recurrent sustained ventricular tachycardia evaluated by use of transient...

Using transient entrainment, the effect of the paced cycle length on the conduction through the reentrant circuit was assessed in recurrent sustained ventricular tachycardia (VT). Fourteen patients were included in the present study and their VTs were paced at multiple cycle lengths while the criteria of entrainment were confirmed at each paced cycle length. Then, the effect of the paced cycle length upon the conduction time, which was evaluated by the measurement of the time interval from stimulus to the entrained electrogram, was analyzed. In the overdrive pacings of VT, 3 response patterns in conduction time were observed: an increasing pattern (n = 8), a flat pattern (n = 5) and a decreasing pattern (n = 1) while the local conduction time outside the reentrant circuit remained unchanged at comparable paced cycle lengths. A decremental property is the likely mechanism responsible for the paced cycle length-dependent prolongation. As for the flat pattern, the existence of a fully excitable gap may be responsible. A paced cycle length related change in the reentrant circuit may account for the decreasing pattern. By using transient entrainment, the electrophysiological characteristics of the reentrant circuit can be evaluated and the information so gathered may be valuable in analyzing the action of antiarrhythmic drugs on the slow pathway.