Attempted entrainment of circus movement tachycardias by ventricular stimulation

Entrainment was attempted while pacing the right ventricle in 12 patients with circus movement tachycardias. At the onset of stimulation eight patients had short episodes of intraventricular and atrioventricular dissociation during which the paced impulses activated the various ventricular recording sites (right and left), but did not reach the atria. The latter occurred because the ventricular electrograms were recorded from parts of the ventricles which were not essential components of the reentry circuit. Relatively long (greater than 5 s) runs of entrainment were not possible in any case because of the relatively prompt termination of the tachycardias. Whereas in three patients this was due to the abrupt appearance of retrograde block in the accessory pathway, in nine patients it happened when the sequential, anterograde and retrograde, penetration of the AV node resulted in AV nodal block of the subsequent, reentering atrial impulse. The findings in this study showed that, with the methodology used, entrainment of circus movement tachycardias by ventricular stimulation had to be defined conceptually, by the fulfillment of requirements which did not include its occurrence for at least 5 seconds. Furthermore, the results also suggested that entrainment and tachycardia termination were best demonstrated by a technique which allowed the emission of the first stimulus in a constant (late) moment of the cycle, with deliverance of one additional stimulus at the same cycle length in successive pacing runs.