Influence of tachycardia cycle length and antiarrhythmic drugs on pacing termination and acceleration of ventricular tachycardia

Gerald V. Naccarelli, Douglas P. Zipes, G. Thomas Rahilly, James J. Heger, Eric N. Prystowsky

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Abstract

We examined the influence of ventricular tachycardia (VT) cycle length and antiarrhythmic drugs on the frequency of VT termination and acceleration by single and double extrastimuli and right ventricular burst pacing. In 57 patients, 89 episodes of sustained VT (32 control, 57 drug) were induced by programmed electrical stimulation. Overall, 60 of 89 (67%) episodes of ventricular tachycardia were terminated by means of programmed electrical stimulation. In patients with relatively slow ventricular tachycardia (VT cycle length ≥ 350 msec) pacing terminated 37 of 44 (84%) episodes but terminated only 23 of 45 (51%) episodes of more rapid VT (VT cycle length ≤ 349 msec, p < 0.005). Pacing successfully terminated VT in nine of 49 (18%) episodes using a single extrastimulus, 22 of 52 (42%) episodes using double extrastimuli, and 40 of 66 (61%) episodes using burst right ventricular pacing. VT acceleration occurred in none of 49 attempts with a single extrastimulus, in eight of 52 (15%) attempts with double extrastimuli, and in 12 of 66 (18%) attempts using burst right ventricular pacing. During therapy, the frequency of either ventricular tachycardia termination or acceleration did not change regardless of the pacing termination method used. However, by prolonging the mean VT cycle length from 311.1 ± 82.2 msec to 401.9 ± 103.5 msec (p < 0.01), drugs increased the overall frequency of VT termination. We conclude that: (1) pacing terminates VT more frequently if the VT cycle length is long and if right ventricular bursts are used, (2) burst right ventricular pacing increases the risk of VT acceleration, and (3) drugs increase the frequency of ventricular tachycardia termination by prolonging VT cycle length but do not affect frequency of VT acceleration.

Original languageEnglish
Pages (from-to)1-5
Number of pages5
JournalAmerican Heart Journal
Volume105
Issue number1
DOIs
StatePublished - 1983

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Anti-Arrhythmia Agents
Ventricular Tachycardia
Tachycardia
Electric Stimulation
Accelerated Idioventricular Rhythm
Drug and Narcotic Control

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Influence of tachycardia cycle length and antiarrhythmic drugs on pacing termination and acceleration of ventricular tachycardia. / Naccarelli, Gerald V.; Zipes, Douglas P.; Rahilly, G. Thomas; Heger, James J.; Prystowsky, Eric N.

In: American Heart Journal, Vol. 105, No. 1, 1983, p. 1-5.

Research output: Contribution to journalArticle

Naccarelli, Gerald V. ; Zipes, Douglas P. ; Rahilly, G. Thomas ; Heger, James J. ; Prystowsky, Eric N. / Influence of tachycardia cycle length and antiarrhythmic drugs on pacing termination and acceleration of ventricular tachycardia. In: American Heart Journal. 1983 ; Vol. 105, No. 1. pp. 1-5.
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abstract = "We examined the influence of ventricular tachycardia (VT) cycle length and antiarrhythmic drugs on the frequency of VT termination and acceleration by single and double extrastimuli and right ventricular burst pacing. In 57 patients, 89 episodes of sustained VT (32 control, 57 drug) were induced by programmed electrical stimulation. Overall, 60 of 89 (67{\%}) episodes of ventricular tachycardia were terminated by means of programmed electrical stimulation. In patients with relatively slow ventricular tachycardia (VT cycle length ≥ 350 msec) pacing terminated 37 of 44 (84{\%}) episodes but terminated only 23 of 45 (51{\%}) episodes of more rapid VT (VT cycle length ≤ 349 msec, p < 0.005). Pacing successfully terminated VT in nine of 49 (18{\%}) episodes using a single extrastimulus, 22 of 52 (42{\%}) episodes using double extrastimuli, and 40 of 66 (61{\%}) episodes using burst right ventricular pacing. VT acceleration occurred in none of 49 attempts with a single extrastimulus, in eight of 52 (15{\%}) attempts with double extrastimuli, and in 12 of 66 (18{\%}) attempts using burst right ventricular pacing. During therapy, the frequency of either ventricular tachycardia termination or acceleration did not change regardless of the pacing termination method used. However, by prolonging the mean VT cycle length from 311.1 ± 82.2 msec to 401.9 ± 103.5 msec (p < 0.01), drugs increased the overall frequency of VT termination. We conclude that: (1) pacing terminates VT more frequently if the VT cycle length is long and if right ventricular bursts are used, (2) burst right ventricular pacing increases the risk of VT acceleration, and (3) drugs increase the frequency of ventricular tachycardia termination by prolonging VT cycle length but do not affect frequency of VT acceleration.",
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