Work

Repetitive ventricular response. Prevalence and prognostic significance.

Year: 1981

Type: article

Abstract: The purpose of this study was to determine the prevalence of repetitive ventricular responses caused by non-bundle-branch re-entry and bundle-branch re-entry in 47 patients with and in 50 patients without ventricular tachycardia.We also compared the prevalence of repetitive ventricular responses using two types of electrophysiological stimulation: single premature ventricular stimulation during sinus rhythm or atrial pacing, and single premature ventricular stimulation during ventricular pacing.In patients who had ventricular tachycardia, premature ventricular stimu- lation during ventricular pacing induced non-bundle-branch re-entry more often than during atrial pacing (70-2% versus 33 3%).Both methods ofstimulation induced non-bundle-branch re-entry more often in patients who had ventricular tachycardia than in those who did not.In both groups of patients, bundle-branch re-entry was rare during atrial pacing and more common but equally prevalent during ventricular pacing.To determine ifinduced non-bundle-branch re-entry could identify patients at risk ofdeveloping future symptomatic ventricular tachycardia or sudden death, 59 patients who had a history of documented ventricular tachycardia had an electrophysiological study just before discharge and were followed for an average of 10 9 months.Non-bundle-branch re-entry induced during ventricular and atrial pacing had a predictive accuracy of 59% and 64%, respectively.The predictive accuracy of non-bundle-branch re-entry induced during atrial pacing appeared to be greater in patients who also had ventricular tachycardia induced during the same electrophysiology study.Our data indicate that:(1) non-bundle-branch re-entry is induced more often during ventricular pacing than during atrial pacing and more often in patients who have a history of ventricular tachycardia than in those who do not; (2) induction of non-bundle-branch re-entry during ventricular pacing is more sensitive and during atrial pacing is more specific; however, neither alone yields a predictive accuracy sufficiently high to make the test clinically useful; and (3) induced non-bundle-branch re-entry during atrial pacing associated with induced ventricular tachycardia may define a high risk group.

Source: Heart

DOI: 10.1136/hrt.46.2.152

Authors: G V Naccarelli, E N Prystowsky, W M Jackman, J J Heger, R L Rinkenberger, D P Zipes