Entrainment of reentrant tachycardia in a computer model

Capture of the cardiac rate by pacing followed by an immediate return to the original rate after pacing has been proposed as characteristic of reentrant rhythms. In this study, such entrainment has been demonstrated using computer-model simulations of propagated excitation and of reentry associated with structural and functional obstacles. With structural obstacles, the mechanism of entrainment was bidirectional propagation of paced excitation in reentry circuits, with collision of the reentrant and paced excitation in one direction and continued propagation of paced excitation in the other direction. The time of pacing onset, rate, and location all affected the QRS waveform during entrainment. With a particular time of onset and rate of pacing, the duration of time during which the QRS waveform underwent dynamic change was directly related to the distance between the pacing site and reentrant circuit. The location of reentry associated with functional obstacles moved so that the relationship between pacing-induced and reentrant excitation varied. In some cycles, pacing did not alter reentrant circuits, that is, entrainment did not occur, while other cycles were entrained, but by a different mechanism than that with structural obstacles. Leading circle reentry circuits, consisting of propagation away from and returning to reentry sites, did not have an excitable gap and paced excitation did not enter those circuits. Paced excitation did, however, enter the propagation paths between leading circle reentry circuits and modified the circuits by affecting the recovery of excitability.