Volume 77, Issue 4, Pages (April 1980)

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Date of download: 7/7/2016 Copyright © The American College of Cardiology. All rights reserved. From: Human atrial repolarization: effects of sinus rate,

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Presentation transcript:

Volume 77, Issue 4, Pages 478-487 (April 1980) Chronic Longterm Electrophysiologic Study of Paroxysmal Ventricular Tachycardia Pablo Denes, M.D., Delon Wu, M.D., Christopher Wyndham, M.D., Ramesh Dhingra, M.D., Robert Bauernfeind, M.D., Steven Swiryn, M.D., Kenneth M. Rosen, M.D., F.C.C.P. CHEST Volume 77, Issue 4, Pages 478-487 (April 1980) DOI: 10.1378/chest.77.4.478 Copyright © 1980 The American College of Chest Physicians Terms and Conditions

Figure 1 Recordings from case 1, showing loss of ability to induce sustained ventricular tachycardia with procainamide and disopyramide. Ventricular tachycardias were induced with ventricular extrastimulus technique. Shown are ECG leads 1, 2, 3 and V1 and right atrial electrogram (RAE). Atrial electrogram is labeled A, and stimulus artifact, S. The driven cycle length (S1-S1) was 500 msec. The Sj was ventricular basic driven stimulus and S2 the ventricular extrastimulus. Cycle length (CL) of induced paroxysmal ventricular tachycardia is given in milliseconds. Paper speed is 100/mm/sec and time lines are at 1 second on this and all subsequent illustrations. Panel A shows induction of sustained ventricular tachycardia before drug administration. The S1-S2 interval is 190 msec and the cycle length (CL) of tachycardia 240 msec. Panel B, induction of nonsustained ventricular tachycardia (CL of 300 mg) following intravenous administration of procainamide; C, induction of nonsustained ventricular tachycardia (CL 320 msec) following orally administered procainamide; D, induction of sustained ventricular tachycardia (CL of 250 msec) following intravenous administration of propranolol; E, induction of a single ventricular reentrant echo following intravenous administration of disopyramide; and F, inability for induction of ventricular tachycardia following orally administered disopyramide. CHEST 1980 77, 478-487DOI: (10.1378/chest.77.4.478) Copyright © 1980 The American College of Chest Physicians Terms and Conditions

Figure 2 Recordings from case 2, demonstrating loss of ability to sustain ventricular tachycardia with disopyramide. Ventricular tachycardia was induced with rapid ventricular pacing. The cycle length of ventricular pacing for induction of tachycardia varied from 300 to 430 msec. The first three panels (A to C) show induction of sustained ventricular tachycardia during control and after intravenously administered procainamide and aprindine. Panel D shows induction of nonsustained ventricular tachycardia following oral administration of disopyramide. Note that the cycle length of tachycardia is lengthened following procainamide, aprindine, and disopyramide. CHEST 1980 77, 478-487DOI: (10.1378/chest.77.4.478) Copyright © 1980 The American College of Chest Physicians Terms and Conditions

Figure 3 Recordings from case 7, demonstrating lack of drug effect on inducibility of ventricular tachycardia with disopyramide and aprindine. HRA represents high right atrial electrogram; HBE, His bundle electrogram, RVA, right ventricular apical electrogram; and V, ventricular electrogram. Panel A, induction of sustained ventricular tachycardia with coupled ventricular pacing during control. After the premature stimulus (S2), a short burst of ventricular tachycardia is initiated which is unlike the patients spontaneous tachycardia and occurs at a rapid rate. The ventricular tachycardia that the patient had documented is seen on the right side of the panel and occurs at a cycle length of 360 msec. Panel B, induction of sustained ventricular tachycardia following cessation of rapid ventricular pacing while orally receiving disopyramide, 1.2 gm/day. The cycle length of ventricular tachycardia is 500 msec. Panel C, induction of sustained ventricular tachycardia following cessation of rapid ventricular pacing while orally receiving aprindine, 150 mg/day. After cessation of rapid ventricular pacing, a burst (4 beats) of rapid ventricular tachycardia is seen at a rapid rate, followed by the reproducibly inducible tachycardia at a cycle length of 520 msec. CHEST 1980 77, 478-487DOI: (10.1378/chest.77.4.478) Copyright © 1980 The American College of Chest Physicians Terms and Conditions

Figure 4 Recording from case 8 demonstrating deleterious drug effect with aprindine during rapid pacing termination of ventricular tachycardia. Panel A, an example of ventricular tachycardia termination with rapid ventricular pacing (CL of 200 msec) during control. Following cessation of pacing a short period of nonsustained ventricular fibrillation is induced which terminates spontaneously and sinus rhythm is resumed. Panel B, ventricular tachycardia termination with rapid ventricular pacing. Following cessation of pacing, sustained ventricular flutter fibrillation is induced which necessitated cardioversion for termination (not shown). CHEST 1980 77, 478-487DOI: (10.1378/chest.77.4.478) Copyright © 1980 The American College of Chest Physicians Terms and Conditions