Upstream stimulation versus downstream stimulation: arrhythmogenesis based on repolarization dispersion in the human heart

摘要: Abstract Objective The purpose of this study was to test the hypothesis that a ventricular tachycardia (VT) induction site has shorter action potential duration (APD) and effective refractory period (ERP) than noninducing site, resulting in collision against longer ERP (“upstream”) as opposed (“downstream,” no collision). Background Induction sustained VT is often feasible at one stimulation while application an identical pacing protocol another fails provoke VT. Methods Sixty-nine patients undergoing programmed for inducibility had monophasic recording/pacing catheters placed right outflow tract (RVOT) apex (RVA) simultaneously. Up three extra-stimuli were introduced 5 10 ms decrements until reached. Upon completion drive cycle it repeated other. Results Thirty-eight inducible VT, nine exclusively by RVA RVOT pacing. Action significantly (12 ± 15 ms, p Conclusions Site specificity underscores role dispersion repolarization refractoriness facilitating re-entry arrhythmias. Upstream with short produces larger facilitates induction.