Epicardial mapping of the onset of ventricular tachycardia initiated by programmed stimulation in the canine heart with chronic infarction.

The initial beats of ventricular tachycardia (VT) induced by programmed stimulation (PS) of the heart have frequently been observed to differ in QRS configuration from the subsequent uniform QRS complexes of tachycardia. The transient nature of these initial beats has made their study difficult during epicardial mapping with conventional, hand-held recording electrodes. Twenty-four dogs were studied with PS 1-10 months after coronary ligation. Twenty-six epicardial electrograms were recorded simultaneously during PS. The data were digitized for computer generation of isochronic maps for any desired beat. Three patterns of initiation were observed in episodes of tachycardia in which the initial beats differed from the subsequent beats of VT (11 of 18 runs of VT). Most frequently, the initial beats of VT originated near the pacing electrode before moving to a stable infarction zone location. Less frequently, the initial beats were due to transient reentry in the bundle branches or a transient shifting of early breakthrough sites in the infarction zone.