Ventricular tachycardia induction: comparison of triple extrastimuli with an abrupt change in ventricular drive cycle...

This study compares two stimulation protocols in 47 patients not inducible with double extrastimuli administered during two paced cycle lengths at the right ventricular apex. Method I uses triple extrastimuli; method II, an abrupt short-to-long change in cycle length, single and double extrastimuli. Clinical arrhythmias included sustained ventricular tachycardia or fibrillation (11 patients; group I); nonsustained ventricular tachycardia (27; group II); and no documented ventricular arrhythmia (9; group III). Together, methods I and II rendered 21 of 47 patients inducible; seven were inducible by both methods. No group III patient became inducible. The two techniques were equally likely to produce tachycardias in groups I and II; to induce rapid, pleomorphic, or sustained tachycardias, and tachycardias greater than 10 beats. Since both methods can be applied at the right ventricular apex and increase sensitivity without producing tachycardia in patients with a low suspicion for ventricular arrhythmias, they may facilitate serial drug testing with an indwelling catheter, reducing the need for left-sided studies.