Significance of pacing cycle lengths in manifest entrainment of orthodromic circus movement tachycardia by ventricular pacing

L. Zaman, Agustin Castellanos, N. C. Saoudi, W. J. Stafford, R. G. Trohman, A. Interian, Robert J Myerburg

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Abstract

The physiology of entrainment of orthodromic circus movement tachycardia (CMT) was studied using ventricular pacing during 18 episodes of induced CMT in 7 patients with atrioventricular (AV) accessory pathways. The first paced impulse was delivered as late as possible in the tachycardia cycle (mean 88 ± 5% of the spontaneous cycle length [CL]). Entrainment was demonstrated by the following criteria: 1:1 retrograde conduction via the accessory pathway; capture of atrial, ventricular and His bundle electrograms at the pacing rate; and resumption of tachycardia at its previous rate after cessation of pacing. The number of ventricular paced impulses ranged from 5 to 14 (mean 8 ± 3), and entrainment occurred in 2 to 7 paced cycles (mean 4 ± 2). Orthodromic activation of a major part of the reentry circuit (manifest entrainment) was demonstrated during 9 episodes by the occurrence of His bundle electrogram preceding the first CMT QRS at the time anticipated from the last paced beat. In the 9 other episodes, persistent retrograde His bundle activation and AV nodal penetration by each paced impulse caused a delay (mean 79 ± 25 ms) in activation of the His bundle preceding the first CMT QRS after the last paced beat. The mean pacing CL achieving manifest entrainment was 92 ± 3% of the tachycardia CL, compared with 84 ± 3% for retrograde AV nodal penetration (p < 0.01). In conclusion, manifest entrainment of orthodromic CMT can be demonstrated by ventricular pacing at very long CLs; shorter CLs may cause CMT termination due to retrograde AV nodal penetration.

Original languageEnglish
Pages (from-to)1325-1331
Number of pages7
JournalAmerican Journal of Cardiology
Volume59
Issue number15
DOIs
StatePublished - Aug 27 1987

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Ventricular Tachycardia
Tachycardia
Cardiac Electrophysiologic Techniques
Bundle of His
Accessory Atrioventricular Bundle

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Significance of pacing cycle lengths in manifest entrainment of orthodromic circus movement tachycardia by ventricular pacing. / Zaman, L.; Castellanos, Agustin; Saoudi, N. C.; Stafford, W. J.; Trohman, R. G.; Interian, A.; Myerburg, Robert J.

In: American Journal of Cardiology, Vol. 59, No. 15, 27.08.1987, p. 1325-1331.

Research output: Contribution to journalArticle

Zaman, L. ; Castellanos, Agustin ; Saoudi, N. C. ; Stafford, W. J. ; Trohman, R. G. ; Interian, A. ; Myerburg, Robert J. / Significance of pacing cycle lengths in manifest entrainment of orthodromic circus movement tachycardia by ventricular pacing. In: American Journal of Cardiology. 1987 ; Vol. 59, No. 15. pp. 1325-1331.
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abstract = "The physiology of entrainment of orthodromic circus movement tachycardia (CMT) was studied using ventricular pacing during 18 episodes of induced CMT in 7 patients with atrioventricular (AV) accessory pathways. The first paced impulse was delivered as late as possible in the tachycardia cycle (mean 88 ± 5{\%} of the spontaneous cycle length [CL]). Entrainment was demonstrated by the following criteria: 1:1 retrograde conduction via the accessory pathway; capture of atrial, ventricular and His bundle electrograms at the pacing rate; and resumption of tachycardia at its previous rate after cessation of pacing. The number of ventricular paced impulses ranged from 5 to 14 (mean 8 ± 3), and entrainment occurred in 2 to 7 paced cycles (mean 4 ± 2). Orthodromic activation of a major part of the reentry circuit (manifest entrainment) was demonstrated during 9 episodes by the occurrence of His bundle electrogram preceding the first CMT QRS at the time anticipated from the last paced beat. In the 9 other episodes, persistent retrograde His bundle activation and AV nodal penetration by each paced impulse caused a delay (mean 79 ± 25 ms) in activation of the His bundle preceding the first CMT QRS after the last paced beat. The mean pacing CL achieving manifest entrainment was 92 ± 3{\%} of the tachycardia CL, compared with 84 ± 3{\%} for retrograde AV nodal penetration (p < 0.01). In conclusion, manifest entrainment of orthodromic CMT can be demonstrated by ventricular pacing at very long CLs; shorter CLs may cause CMT termination due to retrograde AV nodal penetration.",
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