Rate-dependent change in dispersion of repolarisation during ventricular pacing in man

The difference between the end of monophasic action potentials recorded in the outflow tract of right ventricle and the T-wave on the surface electrocardiogram was measured as an estimate for disparity of termination of repolarisation. It was measured during right ventricular pacing at three basic cycle lengths 500, 600 and 700 msec and programmed stimulation with single extra stimuli in 15 patients with coronary arterial disease. The disparity of termination of repolarisation was rate dependent, showing increased values when stimulated at cycle length of 700 ms compared to 600 msec (P less than 0.005) and 500 ms (P less than 0.001). Premature stimulation revealed three different modes in changes of dispersion: in six patients the premature dispersion was increased at the shortest coupling intervals from the effective refractory period. It was unchanged compared to basic values in four, and in the rest of the patients the premature dispersion was reduced at the shortest coupling intervals. These results show that the dispersion of recovery of repolarisation increases at the lower stimulation frequencies. Premature dispersion is not always increased in the closest proximity to V-ERP during programmed ventricular stimulation in patients with ischemic heart disease.