Transient entrainment and interruption of ventricular tachycardia

The effects on spontaneously occurring ventricular tachycardia of rapidly pacing the right ventricle at rates faster than the rate of the ventricular tachycardia were studied during 10 episodes in seven patients. In three episodes, ventricular pacing interrupted the ventricular tachycardia at the initial pacing rate (111%, 114%, and 119% of the ventricular tachycardia rate, respectively). In seven episodes, the initial pacing rate failed to interrupt the ventricular tachycardia. In six of those seven episodes, the ventricular tachycardia was transiently entrained to the faster pacing rates. In one of those seven episodes, transient entrainment of the ventricular tachycardia could not be distinguished from over-drive suppression. In all seven episodes, the tachycardia was later interrupted by pacing at more rapid rates. The successful pacing rate ranged from 111-141% (mean 125%) of the spontaneous ventricular tachycardia rate. It is concluded that when utilizing rapid ventricular pacing to interrupt ventricular tachycardia, a critical pacing rate may be required before interruption is achieved. Pacing at rates slower than the critical rate but faster than the spontaneous ventricular tachycardia rate may only transiently entrain the ventricular tachycardia to the pacing rate without interrupting it. During the period of transient entrainment, fusion QRS complexes are likely to be present.