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Related Experiment Videos

Polymorphic ventricular tachycardia induced by programmed stimulation: response to procainamide

A E Buxton1, M E Josephson, F E Marchlinski

  • 1Clinical Electrophysiology Laboratory, Hospital of the University of Pennsylvania, Philadelphia.

Journal of the American College of Cardiology
|January 1, 1993
PubMed
Summary

Procainamide converts inducible polymorphic ventricular tachycardia to uniform ventricular tachycardia in patients with coronary artery disease. This conversion aids in mapping and treating complex cardiac arrhythmias.

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Pharmacology

Background:

  • Polymorphic ventricular tachycardia (PVT) is frequently induced during electrophysiologic studies.
  • Its clinical relevance varies, with some cases being artifacts and others indicating underlying pathology.
  • Type IA antiarrhythmic agents may alter the response to programmed stimulation from PVT to uniform ventricular tachycardia (UVT).

Purpose of the Study:

  • To assess procainamide's effect on programmed stimulation-induced PVT.
  • To correlate these responses with cardiac conditions, left ventricular activation, and signal-averaged ECG.
  • To explore the diagnostic and therapeutic implications of procainamide-induced VT conversion.

Main Methods:

  • Programmed right ventricular stimulation was conducted before and after procainamide administration.

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  • Signal-averaged electrocardiograms (SAECG) and left ventricular endocardial activation mapping were performed during sinus rhythm.
  • Seventy-nine patients with inducible PVT were evaluated.

    • Main Results:

    • Procainamide converted PVT to UVT in 24 patients (Group 1), while PVT persisted in 30 (Group 2), and 25 had no inducible VT (Group 3).
    • Group 1 patients showed significantly higher rates of coronary artery disease (96%), left ventricular aneurysms (46%), and abnormal SAECGs and LV activation maps.
    • These findings suggest a strong association between procainamide-induced VT conversion and structural heart disease.

    Conclusions:

    • Conversion of inducible PVT to UVT by procainamide predominantly occurs in patients with coronary disease, prior myocardial infarction, and impaired left ventricular function.
    • This procainamide-induced conversion facilitates activation mapping of ventricular tachycardia.
    • Enabling potential therapeutic interventions like surgical or catheter ablation for previously untreatable arrhythmias.