Overdrive pacing of triggered atrial and ventricular arrhythmias in canine models consistently shortened recovery intervals and increased inducibility at faster drive rates.
Does overdrive pacing elicit consistent electrophysiologic responses in triggered atrial and ventricular arrhythmias in canine models?
Overdrive pacing elicits consistent electrophysiologic responses in diverse triggered arrhythmias in canine models, suggesting its potential utility in clinically differentiating triggered rhythms from reentry.
Although triggered activity has been identified in isolated atrial tissue with the use of cellular electrophysiologic techniques, there has been no identification of triggered atrial arrhythmias in situ. Moreover, it is unclear whether triggered rhythms of different causes and sites of origin in the heart exhibit uniform responses to pacing that might aid in their identification. We therefore studied arrhythmias induced by overdrive pacing in three canine preparations, and based the analysis of our results on guidelines derived from microelectrode studies. We studied ventricular tachycardias induced by ouabain or by anterior wall myocardial infarction and atrial (coronary sinus) arrhythmias induced by the infusion of epinephrine into the great cardiac vein. In the ouabain and postinfarction preparations, right ventricular epicardial pacing induced ventricular premature beats or tachycardias whose recovery intervals after cessation of pacing shortened and showed overdrive acceleration as pacing rate increased. The first postpacing beat displayed progressive fusion with the paced beats but transient entrainment could not be induced. In the coronary sinus, the recovery intervals of impulses induced by epinephrine and pacing decreased as the drive rate increased, and inducibility of the paced rhythms increased at faster drive rates. Thus, the recovery intervals of triggered activity induced in the coronary sinus are phenomenologically similar to those of infarct- and digitalis-induced triggered rhythms. This is the first demonstration of consistent behavior in response to pacing of diverse types of triggered activity. Considered in light of the failure to induce transient entrainment, the results emphasize the potential utility of pacing in clinical identification of triggered rhythms and their differentiation from reentry.
Malfatto et al. (Sun,) conducted a other in Triggered atrial and ventricular arrhythmias. Overdrive pacing was evaluated on Recovery intervals and inducibility of paced rhythms. Overdrive pacing of triggered atrial and ventricular arrhythmias in canine models consistently shortened recovery intervals and increased inducibility at faster drive rates.