Faculty Collaboration Database

Programmed electrical stimulation protocols: variations on a theme. Pacing Clin Electrophysiol 1992 Nov;15(11 Pt 2):2180-7

Date

11/01/1992

Pubmed ID

1279622

DOI

10.1111/j.1540-8159.1992.tb03044.x

Scopus ID

2-s2.0-0026545770 (requires institutional sign-in at Scopus site)   6 Citations

Abstract

A series of prospective protocols were designed to determine the yield ratio (true positives vs. false positives = nonclinical) in various patient groups using a variety of programmed electrical stimulation (PES) variables. First, a PES protocol was used in 772 patients. Single, double, and triple extrastimuli were delivered in sequence (leaving each successive extrastimulus just beyond its refractory period before moving to the next extrastimulus) during sinus rhythm and two ventricular paced rates at the RV apex, before moving to the outflow tract and repeating the sequence and then moving on to isoproterenol infusion with the PES sequence repeated at the apex. This protocol met NASPE standards for induction of VT in patients with coronary artery disease and a history of VT, while failing to induce monomorphic VT in any control patient. The best yield ratios combined with the greatest likelihood of inducing clinical tachycardia were achieved with sinus rhythm and three extrastimuli, and pacing at the lower rate and three extrastimuli. Pacing at the faster rate and triple extrastimuli was highly inductive of clinical arrhythmias, but had a low yield ratio due to induction of more nonclinical arrhythmias than other steps. The next protocol was performed in 61 patients with inducible ventricular tachycardia. In each case, the protocol described above was completed at the RV apex, even if tachycardia was also induced at an earlier point in the protocol. This allowed for more accurate yield ratios to be established for each step in the protocol, since each patient was exposed to each of these steps.(ABSTRACT TRUNCATED AT 250 WORDS)

Author List

Fisher JD, Kim SG, Ferrick KJ, Roth J

Author

James A. Roth MD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Arrhythmias, Cardiac
Cardiac Pacing, Artificial
Clinical Protocols
Heart Conduction System
Humans
Predictive Value of Tests
Refractory Period, Electrophysiological
Sensitivity and Specificity
Tachycardia, Ventricular
Ventricular Fibrillation