Programmed ventricular stimulation in patients without spontaneous ventricular tachycardia

Area of Science:

• Electrophysiology
• Cardiology
• Cardiac Arrhythmias

Background:

• Programmed ventricular stimulation (PVS) is used to assess arrhythmia risk.
• Understanding PVS predictability in patients without prior documented arrhythmias is crucial.

Purpose of the Study:

• To evaluate the predictive value of PVS in patients without a history of spontaneous ventricular tachycardia (VT) or ventricular fibrillation (VF).
• To determine the induction rates of different VT/VF types based on structural heart disease and stimulation parameters.

Main Methods:

• PVS was performed in 52 patients without prior VT/VF history.
• Stimulation from right ventricular (RV) and left ventricular (LV) apex using up to three extrastimuli.
• Analysis of induced arrhythmias: intraventricular reentry, nonsustained VT, sustained VT, and sustained VF.

Main Results:

• Nonsustained VT was induced in 45% of patients with mitral valve prolapse and 37% with other heart diseases, but never in those without structural heart disease.
• Sustained VT was not induced in any patient without prior VT/VF.
• Sustained VF was induced in two patients without prior VT/VF history.

Conclusions:

• A maximal response of repetitive beats has no predictive value.
• Nonsustained VT induction during PVS is associated with structural heart disease.
• Sustained VT induction is specific to patients with a history of spontaneous VT/VF.
• Sustained VF can be infrequently induced even in patients without prior VT/VF history.