Repetitive ventricular response. Prevalence and prognostic significance.

Open Access
Publisher Website
Google Scholar
Abstract
The prevalence of repetitive ventricular responses caused by non-bundle-branch re-entry and bundle-branch re-entry was determined in 47 patients with and in 50 patients without ventricular tachycardia. The prevalence of repetitive ventricular responses using 2 types of electrophysiological stimulation was compared: single premature ventricular stimulation during sinus rhythm or atrial pacing; and single premature ventricular stimulation during ventricular pacing. In patients who had ventricular tachycardia, premature ventricular stimulation during ventricular pacing induced non-bundle-branch re-entry more often than during atrial pacing (70.2 vs. 33.3%). Both methods of stimulation induced non-bundle-branch re-entry more often in patients who had ventricular tachycardia than in those who did not. In both groups of patients, bundle-branch re-entry was rare during atrial pacing and more common but equally prevalent during ventricular pacing. To determine if induced non-bundle-branch re-entry could identify patients at risk of developing future symptomatic ventricular tachycardia or sudden death, 59 patients who had a history of documented ventricular tachycardia had an electrophysiological study just before discharge and were followed for an average of 10.9 mo. Non-bundle-branch re-entry induced during ventricular and atrial pacing and a predictive accuracy of 59% and 64%, respectively. The predictive accuracy of non-bundle-branch re-entry induced during atrial pacing appeared to be greater in patients who also had ventricular tachycardia induced during the same electrophysiology study. Non-bundle-branch re-entry is induced more often during ventricular pacing than during atrial pacing and more often in patients who have a history of ventricular tachycardia than in those who do not: induction of non-bundle-branch re-entry during ventricular pacing is more sensitive and during atrial pacing is more specific; however, neither alone yields a predictive accuracy sufficiently high to make the test clinically useful. Induced non-bundle-branch re-entry during atrial pacing associated with induced ventricular tachycardia may define a high risk group.