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Ultrarapid Train Stimulation Versus Conventional Programmed Electrical Stimulation for Induction of Ventricular Arrhythmias in Patients with Coronary Artery Disease

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Abstract

Conventional programmed electrical stimulation (PES) of the ventricle isuseful for establishing inducibility or noninducibility of clinicalventricular arrhythmias (VA) but is complex and time consuming. The presentstudy was designed to compare a standard PES protocol with an alternativemethod using ultrarapid train stimulation in patients with VA and coronaryartery disease (CAD). A prospective, randomized, crossover design was used.During each session in the electrophysiology laboratory, patients werestudied using both the trains and PES protocols in randomized order. In 82matched pairs of comparisons in 50 patients, results were concordant in85% (p < 0.0001). There were no differences related to type ofclinical arrhythmia or to the presence of antiarrhythmic drugs. There wereno significant differences in the induction of nonclinical arrhythmias withthe two methods (p < 0.0001 for concordance). There were no significantdifferences related to the cycle length of the trains (10, 20, or 30 ms,equivalent to 100, 50, or 33 Hz). The number of drive-extrastimuli sequencesand the time required to complete the trains protocol was significantlyshorter (p < 0.0001) using trains versus PES. Ultrarapid train stimulationprovides results in CAD patients that are comparable with those ofconventional PES protocols. There is a significant savings in time, addingpractical value to intrinsic electrophysiologic interest. Trains may beuseful when multiple inductions are desirable, for example, in the settingof antitachycardia pacing parameters in an implantable defibrillator (ICD),during ICD implantation, or in other circumstances where the main questionis inducibility of ventricular arrhythmias.

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Authors and Affiliations

  1. Department of Medicine, Division of Cardiology, Arrhythmia Service, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, USA

    John D. Fisher, Mark C Cua, Simie B Platt, Lawrence E. Waspe, Soo G Kim, Kevin J. Ferrick & James A. Roth

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  1. John D. Fisher
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  2. Mark C Cua
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  3. Simie B Platt
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  4. Lawrence E. Waspe
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  6. Kevin J. Ferrick
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Fisher, J.D., Cua, M.C., Platt, S.B. et al. Ultrarapid Train Stimulation Versus Conventional Programmed Electrical Stimulation for Induction of Ventricular Arrhythmias in Patients with Coronary Artery Disease. J Interv Card Electrophysiol 1, 15–21 (1997). https://doi.org/10.1023/A:1009754432146

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