Arrhythmias and Conduction Disturbances

Coupling intervals of extrastimuli that induced 57 previously documented unimorphic ventricular tachycardias (VTs) were compared with coupling intervals that induced 57 episodes of polymorphic VT or ventricular fibrillation (VF) in patients wlthout a documented or suspected history of polymorphic VT or VF. Programmed stimulation was performed with the patient in the drug-free state, with 1 to 3 extrastimuli and 2 basic drive cycle lengths (600 or 500 ms, and 400 ms) at 2 right ventricular sites; stimuli were twice diastolic threshold. The mean coupling intervals of the first, second and third extrastimuli that induced nonclinical VT/!/F (241 f 19, 165 f 19 and 173 f 24 ms, respectively, mean f standard deviation) were significantly shorter than the corresponding coupling intervals that induced the clinical Vls (266 f 25, 228 f 32 and 214 f 27 ms, respectively, p <O.OOl for each). Regardless of the basic drive cycle length, the shortest coupling interval required to induce a clinical VT was 180 ms. depending on the drive cycle length, 29 to 70% of nonclinical W/VF induced by 3 extrastimull required a coupling interval of less than 180 ms to Induce. Therefore, a lower limit of coupling intervals may be identified belovv which only nonclinical VT/VP is induced by programmed stimulation. Restriction of coupling intervals to this lower limit may allow for significant Improvement in specificity without compromise in the sensitivity of programmed ventricular stimulation protocols.