Programmed electrical stimulation of the heart in patients with life-threatening ventricular arrhythmias: what is the significance of induced arrhythmias and what is the correct stimulation protocol?

Wellens, Hein J.J.; Brugada, Pedro; Stevenson, William G.

doi:10.1161/01.cir.72.1.1

Cited by 267 publications

(60 citation statements)

References 16 publications

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“…The use of a more rigorous and standarized stimulation protocol (double and triple extrastimulation) in all patients in the future would both increase the number of patients in whom ventricular tachycardia could be induced, and allow postulations regarding the mechanism. [55][56][57][58] Treatment. Once the decision to treat was made, a drug effective in preventing or controlling ventricular tachycardia could be identified in 14 of 17 patients (82%) with a combined approach of programmed stimulation, treadmill testing, and Holter monitoring.…”

Section: Discussionmentioning

confidence: 99%

Ventricular tachycardia in a young population without overt heart disease.

Deal¹,

Miller²,

Scagliotti³

et al. 1986

Circulation

167

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Since 1974, 24 young patients presenting with ventricular tachycardia and without clinical evidence of heart disease were evaluated and followed. Sixteen patients (67%) were symptomatic. Clinical episodes of ventricular tachycardia were sustained in 18, incessant in four, and nonsustained in two patients. The rate of tachycardia ranged from 130 to 300 beats/min (mean = 200 beats/min). Subtle abnormalities of cardiac size or function were present at cardiac catheterization in 16 of 23 patients (70%). During electrophysiologic studies, spontaneous ventricular tachycardia was present in six patients. The clinical ventricular tachycardia was inducible by programmed stimulation in 13 of 18 patients. The site of origin of tachycardia based on endocardial mapping in 17 patients was the right ventricle in 14, the ventricular septum in one, and indeterminate in two patients. Seventeen patients were treated based on results of short-term drug testing. During a mean follow-up period of 7.5 years, three patients died suddenly; none of these patients were receiving antiarrhythmic medication at the time of death. We conclude that in a young population without clinical evidence of heart disease, ventricular tachycardia may be the first manifestation of cardiomyopathy, since at least two-thirds of these patients have abnormalities at cardiac catheterization. Without treatment mortality in this population may be as high as 13% over an 8 year period. Presently we recommend treatment of ventricular tachycardia in any symptomatic patient, with therapy guided by electrophysiologic and treadmill testing. In addition, we recommend treatment for any asymptomatic patient with exercise-related tachycardia, since this group appears to be at increased risk for sudden death. Finally, we would seriously consider treating any asymptomatic patient in whom sustained monomorphic ventricular tachycardia can be induced by standard programmed stimulation protocols, although the long-term prognosis in this group is uncertain.

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Section: Discussionmentioning

confidence: 99%

Ventricular tachycardia in a young population without overt heart disease.

Deal¹,

Miller²,

Scagliotti³

et al. 1986

Circulation

167

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“…Protocol for initiation and optogenetic defibrillation of VT. Sustained arrhythmia (≥5 seconds of self-sustained re-entrant activity) was initiated by a rapid pacing sequence resembling the clinical protocol for electrophysiological study in VT patients (59). A train of six 10-ms-long electrical stimuli (S1) was delivered to the ventricular apex at a cycle length of 350 ms.…”

Section: Methodsmentioning

confidence: 99%

“…We validated this approach in earlier work concerned with simulation of optical mapping experiments (20). Optical parameters of myocardium were derived from experimentally measured values for cardiac tissue (59) and depended on whether the applied illumination was blue (λ = 488 nm, D = 0.18 mm, μ a = 0.52 mm ). As shown in Supplemental Figure 5, this resulted in significantly deeper light penetration for red stimuli (approximate exponential decay rate δ = 1.84 mm) compared with blue stimuli (δ = 0.588 mm).…”

Section: Methodsmentioning

confidence: 99%

Optogenetic defibrillation terminates ventricular arrhythmia in mouse hearts and human simulations

Bruegmann¹,

Boyle²,

Vogt³

et al. 2016

Journal of Clinical Investigation

158

182

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“…The major concern with programmed electrical stimulation as part of an electrophysiological study for inducing clinically significant ventricular arrhythmia, is its varying sensitivity (and specificity) in different clinical settings [190] and the lack of a standard protocol [191] ( Table 2.5). Generally speaking, programmed electrical stimulation is thought to be a sensitive tool in patients with chronic ischaemic heart disease (previous myocardial infarction) and susceptibility for spontaneous monomorphic ventricular tachycardia.…”

Section: Syncope In Patients With Bundle Branch Block (Impending Highmentioning

confidence: 99%