Pacing to Predict Mechanism: Transient Entrainment and Reentry
As summarized recently , until the last decade or so, it was generally thought that cardiac rhythms resulted either from an automatic mechanism or a reentrant mechanism. Nevertheless, apart from the early and classic experiments of Mayer  on reentry in the Medusa ring, and subsequent studies by Mines  on ring preparations cut from dogfish auricles or from canine right ventricles, it was only with the publications of the in vitro studies of depressed bundles and loops of canine Purkinje fibers in 1972 by Wit et al. [4, 5] that the occurrence of reentry actually was documented. Before the latter studies, reentrant mechanisms had been postulated as being present in many arrhythmias, but this postulate was based primarily on indirect evidence. In fact, for in vivo rhythms, it had been thought that one could distinguish reentrant arrhythmias from automatic rhythms by a few key characteristics. Simply stated, it was generally accepted that if the rhythm could be either initiated or terminated by premature beats or rapid pacing, the rhythm was due to a reentry mechanism .
KeywordsCatheter Ischemia Cardiol Rosen Serpentine
Unable to display preview. Download preview PDF.
- 1.Cranefield, P.F. 1975. The Conduction of the Cardiac Impulse. The Slow Response and Cardiac Arrhythmias. Mt. Kisco, NY, Futura Publishing Co.Google Scholar
- 2.Mayer, A.G. 1908. Rhythmical pulsation in scyphomedusae. II. in Papers from the Tortugas Laboratory of the Carnegie Institution of Washington, 1:113.Google Scholar
- 3.Mines, G.R. 1914. On circulating excitations in heart muscles and their possible relation to tachycardia and fibrillation. Trans. R. Soc. Can. Ser 3, sec 4, 8:43.Google Scholar
- 11.Olshansky, B., Okumura, K., Henthorn, R.W., et al. 1986. Entrainment of human atrial flutter localizes the area of slow conduction in the inferior right atrium (abstr.) J. Am. Coll. Cardiol. 7:128A.Google Scholar
- 16.Plumb, V.J., Henthorn R.W., and Waldo, A.L. 1984. Characteristics of the transient entrainment of ventricular tachycardia by ventricular pacing (abstr.). PACE 7:463.Google Scholar
- 24.Portillo, B., Mejias, J., Leon-Portillo, N., et al. 1984. Entrainment of atrioventricular nodal reentrant tachycardias during overdrive pacing from high right atrium and coronary sinus: with special reference to atrioventricular dissociation and 2:1 retrograde block during tachycardias. Am. J. Cardiol. 53:1750–1756.CrossRefGoogle Scholar
- 27.El-Sherif, N., Gough, W.B., and Restivo, M. 1986. The mechanism for “entrainment” in termination of reentrant ventricular tachycardia by overdrive pacing (abstr.). J. Am. Coll. Cardiol. 7:40A.Google Scholar
- 28.Dillon, S., and Wit, A.L. 1986. Mechanisms for effects of overdrive on reentrant ventricular tachycardia, (abstr.) Circulation 74:11–118.Google Scholar
- 31.Boyden, P.A., Frame, L.H., and Hoffman, B.H. 1986. Activation patterns during transient entrainment of reentrant excitation in isolated canine atrium (abstr.). Circulation 74:11–350.Google Scholar
- 33.Wit, A.L., and Rosen, M.R. 1986. Afterdepolarizations and triggered activity. In The Heart and Cardiovascular System. Scientific Foundations, H.A. Fozzard, E. Haber, R.B. Jennings, et al., eds. p. 1449, New York, Raven Press.Google Scholar
- 34.Morady, F., Schienman, M.M., DiCarlo, L.A., Jr., et al. 1987. Results of transcatheter ablation of ventricular tachycardia in 33 patients (abstr.). J. Am. Coll. Cardiol. 9:250A.Google Scholar
- 35.Frank, R., Tonet, J.L., Kounde, S., et al. 1987. Localization of the area of slow conduction during ventricular tachycardia. In Cardiac Arrhythmias: Where To Go From Here? P. Brugada and HJ.J. Wellens eds. p. 191–268, Mt. Kisco, NY, Futura Publishing Co.Google Scholar