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Increased cardiac electrical instability concomitant with pacing induced repolarisation abnormalities.

P Della Bella, S Grazi, C M Cipolla

    British Heart Journal
    |February 1, 1987
    PubMed
    Summary
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    Right ventricular pacing can induce repolarization abnormalities, increasing ventricular arrhythmias in patients with sick sinus syndrome. These abnormalities resolve as the electrocardiogram returns to normal, suggesting pacing-induced changes can affect electrical stability.

    Area of Science:

    • Cardiology
    • Electrophysiology

    Background:

    • Sick sinus syndrome diagnosis often requires electrophysiological studies.
    • Right ventricular pacing can reveal underlying cardiac electrical instability.
    • Repolarization abnormalities are key indicators of ventricular electrical health.

    Purpose of the Study:

    • To investigate the relationship between right ventricular pacing-induced repolarization abnormalities and spontaneous arrhythmias.
    • To determine if pacing-induced electrocardiogram changes correlate with increased ventricular electrical instability.
    • To assess the diagnostic implications of post-pacing repolarization changes in patients with suspected sick sinus syndrome.

    Main Methods:

    • 16 patients with suspected sick sinus syndrome underwent electrophysiological studies.

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  • Patients were randomized into a study group (12-hour right ventricular pacing) and a control group.
  • Electrocardiogram (ECG) and Holter monitoring were used to assess repolarization and arrhythmias before, during, and after pacing.

    • Main Results:

    • Right ventricular pacing induced T-wave inversion and QTc interval prolongation in the study group.
    • Ventricular arrhythmias, including extrasystoles, increased significantly after pacing in 6/8 patients.
    • Arrhythmia frequency decreased as ECG repolarization normalized, indicating a reversible effect.
    • The control group showed no significant changes in repolarization or arrhythmias.

    Conclusions:

    • Post-pacing repolarization abnormalities reflect underlying abnormal ventricular electrical properties.
    • These abnormalities can transiently increase ventricular electrical instability and arrhythmia risk.
    • Right ventricular pacing may unmask latent electrical instability in susceptible individuals.