Abstract
The word entrainment was derived from entrain, “to draw along.” It was first applied to cardiac electrophysiology by Dr. Albert Waldo in 1977. It is one of the most important concepts in clinical cardiac electrophysiology, a concept that remained an intellectual curiosity for many years until catheter ablation entered the clinical arena for the treatment of supraventricular and ventricular tachycardia (VT). In this chapter, the author discusses the history of entrainment and reentry in deciphering the mechanism of cardiac arrhythmias as well as the methodology of entrainment mapping to determine the critical isthmus in various tachycardias. Additionally, the author highlights the contributions of George Ralph Mines in describing reentry as far back as 1913 and those of Dr. William G. Stevenson in entrainment mapping of ventricular tachycardia for catheter ablative purposes.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Definition of Entrain by Merriam-Webster Dictionary.
Waldo AL, MacLean AH, Karp RB, et al. Entrainment and interruption of atrial flutter with atrial pacing. Studies in man following open heart surgery. Circulation. 1977;56(5):737–45.
Mines GR. On dynamic equilibrium in the heart. J Physiol. 1913;46(4-5):349–81, p. 370
Albert L, Waldo F, Richard W, Henthorn VL, Plumb F, William AH, Maclean F. Demonstration of the mechanism of transient entrainment and interruption of ventricular tachycardia with rapid atrial pacing. J Am Coll Cardiol. 1984;3:422–30.
Zipes DP. Mechanism of clinical arrhythmias. J Cardiovc Electrophysiol. 2003;14:902–12.
Stevenson WG, Friedman PL, Sager PT, et al. Exploring postinfarction reentrant ventricular tachycardia with entrainment mapping. J Am Coll Cardiol. 1997;29:1180–9.
Henthorn RW, Okumura K, Olshansky B, et al. A fourth criterion for transient entrainment: the electrogram equivalent of progressive fusion. Circulation. 1988;77(5):1003–12.
Okumura K, Henthorn RW, Epstein AE, Plumb VJ, Waldo AL. Further observations on transient entrainment: importance of pacing site and properties of the components of the reentry circuit. Circulation. 1985;72:1293–307.
Suyama K, Ohe T, Kurita T, Maruyama T, Takaki H, Aihara N, et al. Significance of ventricular pacing site in manifest entrainment during orthodromic atrioventricular reentrant tachycardia with left-sided accessory pathway. Pacing Clin Electrophysiol. 1992;15:1114–21.
Ormaetxe JM, Almendral J, Arenal A, et al. Ventricular fusion during resetting and entrainment of orthodromic supraventricular tachycardia involving septal accessory pathways. Implications for the differential diagnosis with atrioventricular nodal reentry. Circulation. 1993;88:2623–31.
Miyazaki H, Stevenson WG, Stephenson K, et al. Entrainment mapping for rapid distinction of left and right atrial tachycardias. Heart Rhythm. 2006;3:516–23.
Pathik B, Lee G, Nalliah C, et al. Entrainment and high density three dimensional mapping in right atrial macro-reentry provide critical complementary information: entrainment may unmask “visual reentry” as passive. Heart Rhythm. 2017;14:1541–9.
Stevenson WG, Khan H, Sager P, et al. Identification of reentry circuit sites during catheter mapping and radiofrequency ablation of ventricular tachycardia late after myocardial infarction. Circulation. 1993;88:1647–70.
Ellison KE, Friedman PL, Ganz LI, et al. Entrainment mapping and radiofrequency catheter ablation of ventricular tachycardia in right ventricular dysplasia. J Am Coll Cardiol. 1998;32:724–8.
Soejima K, Stevenson WG, Maisel WH, et al. The N + 1 difference: a new measure for entrainment mapping. J Am Coll Cardiol. 2001;37:1386–94.
Soejima K, Stevenson WG, Maisel WH, et al. Electrically unexcitable scar mapping based on pacing threshold for identification of the reentry circuit isthmus: feasibility for guiding ventricular tachycardia ablation. Circulation. 2002;106:1678–83.
Lopera G, Stevenson WG, Soejima K, et al. Identification and ablation of three types of ventricular tachycardia involving the his-Purkinje system in patients with heart disease. J Cardiovasc Electrophysiol. 2004;15:52–8.
Stevenson WG. Current treatment of ventricular arrhythmias: state of the art. Heart Rhythm. 2013;10:1919–26.
Kumar S, Tedrow UB, Stevenson WG. Entrainment mapping. Cardiac Electrophysiol Clin. 2017;9(1):55–69.
Benito B, Josephson ME. Ventricular tachycardia in coronary artery disease. Rev Esp Cardiol. 2012;65:939–55.
Issa ZF, MIller JM, Zipes DP. Mapping and navigation modalities. In: Issa ZF, MIller JM, Zipes DP, editors. Clinical arrhythmology and electrophysiology: a companion to Braunwald’s heart disease. 1st ed. China: Saunders; 2009. p. 57–99.
Almendral JM, Gottlieb CD, Rosenthal ME, et al. Entrainment of ventricular tachycardia: explanation for surface electrocardiographic phenomena by analysis of electrograms recorded within the tachycardia circuit. Circulation. 1988;77:569–80.
Bogun F, Krishnan SC, Marine JE, et al. Catheter ablation guided by termination of postinfarction ventricular tachycardia by pacing with nonglobal capture. Heart Rhythm. 2004;4:422–6.
Bogun F, Bahu M, Knight BP, et al. Comparison of effective and ineffective target sites that demonstrate concealed entrainment in patients with coronary artery disease undergoing radiofrequency ablation of ventricular tachycardia. Circulation. 1997;95:183–90.
Santangeli P, Dixit S. Role of entrainment in the era of high-density activation mapping for characterizing the reentrant circuit. Heart Rhythm. 2017;14(10):1550–1.
Tung R. Challenges and pitfalls of entrainment. Mapping of ventricular Tachycardia. Ten illustrative concepts. Circ Arrhythm Electrophysiol. 2017;10:e004560. https://doi.org/10.1161/CIRCEP.116.004560.
El-Sherif N, Gough WB, Restivo M. Reentrant ventricular arrhythmias in the late myocardial infarction period: 14. Mechanisms of resetting, entrainment, acceleration, or termination of reentrant tachycardia by programmed electrical stimulation. Pacing Clin Electrophysiol. 1987;10:341–71.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Gomes, J.A. (2020). The Concept of Entrainment. In: Heart Rhythm Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-45066-3_5
Download citation
DOI: https://doi.org/10.1007/978-3-030-45066-3_5
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-45065-6
Online ISBN: 978-3-030-45066-3
eBook Packages: MedicineMedicine (R0)