Comparison of ramp and stepwise incremental pacing in assessment of antegrade and retrograde conduction

X. Zhang, John Devens Fisher, Soo G. Kim, J. A. Matos, L. E. Waspe, C. Johnson

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Conventional assessment of antegrade (AV) and retrograde (VA) conduction involves stepwise increments in pacing rates until block in conduction is observed. This study was designed to establish the comparative characteristics of ramp pacing, in which the rate is continuously and smoothly incremented until block occurs. Two hundred and ten patients participated in portions of this study. Stepwise pacing was performed in 10 beat/minute steps, with the rate held for at least 15 seconds at each step; if marked prolongation or variability in conduction was observed, the rate was held constant for up to 60 seconds to allow for accommodation. With ramp pacing, the rate was gradually increased at a steady 2-4 beats/minute/second. Whenever possible, both stepwise and ramp pacing were performed for assessment of both antegrade and retrograde conduction. All patients had conducted sinus rhythm as their baseline mechanism. Antegrade conduction was similar using incremental stepwise and ramp pacing. The AH interval at a cycle length (CL) of 500 ms, the maximum AH increment, the cycle length at AV block were all remarkably similar (p = NS). Assessment of retrograde conduction produced similar results, with insignificant differences between maximum conducted VA intervals, and cycle length at VA block using the two pacing techniques. Ramp pacing provides a useful and rapid alternative to conventional stepwise incremental pacing in the assessment of antegrade and retrograde conduction in patients using both normal and accessory pathways. Ramp pacing was better tolerated, and some correlations between antegrade and retrograde conduction were stronger with the ramp pacing technique.

Original languageEnglish (US)
Pages (from-to)42-52
Number of pages11
JournalPACE - Pacing and Clinical Electrophysiology
Volume9
Issue number1 I
DOIs
StatePublished - 1986

Fingerprint

Architectural Accessibility
Atrioventricular Block

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comparison of ramp and stepwise incremental pacing in assessment of antegrade and retrograde conduction. / Zhang, X.; Fisher, John Devens; Kim, Soo G.; Matos, J. A.; Waspe, L. E.; Johnson, C.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 9, No. 1 I, 1986, p. 42-52.

Research output: Contribution to journalArticle

Zhang, X. ; Fisher, John Devens ; Kim, Soo G. ; Matos, J. A. ; Waspe, L. E. ; Johnson, C. / Comparison of ramp and stepwise incremental pacing in assessment of antegrade and retrograde conduction. In: PACE - Pacing and Clinical Electrophysiology. 1986 ; Vol. 9, No. 1 I. pp. 42-52.
@article{d5cae86924d64d8b9aa3350eb5390cd6,
title = "Comparison of ramp and stepwise incremental pacing in assessment of antegrade and retrograde conduction",
abstract = "Conventional assessment of antegrade (AV) and retrograde (VA) conduction involves stepwise increments in pacing rates until block in conduction is observed. This study was designed to establish the comparative characteristics of ramp pacing, in which the rate is continuously and smoothly incremented until block occurs. Two hundred and ten patients participated in portions of this study. Stepwise pacing was performed in 10 beat/minute steps, with the rate held for at least 15 seconds at each step; if marked prolongation or variability in conduction was observed, the rate was held constant for up to 60 seconds to allow for accommodation. With ramp pacing, the rate was gradually increased at a steady 2-4 beats/minute/second. Whenever possible, both stepwise and ramp pacing were performed for assessment of both antegrade and retrograde conduction. All patients had conducted sinus rhythm as their baseline mechanism. Antegrade conduction was similar using incremental stepwise and ramp pacing. The AH interval at a cycle length (CL) of 500 ms, the maximum AH increment, the cycle length at AV block were all remarkably similar (p = NS). Assessment of retrograde conduction produced similar results, with insignificant differences between maximum conducted VA intervals, and cycle length at VA block using the two pacing techniques. Ramp pacing provides a useful and rapid alternative to conventional stepwise incremental pacing in the assessment of antegrade and retrograde conduction in patients using both normal and accessory pathways. Ramp pacing was better tolerated, and some correlations between antegrade and retrograde conduction were stronger with the ramp pacing technique.",
author = "X. Zhang and Fisher, {John Devens} and Kim, {Soo G.} and Matos, {J. A.} and Waspe, {L. E.} and C. Johnson",
year = "1986",
doi = "10.1111/j.1540-8159.1986.tb05360.x",
language = "English (US)",
volume = "9",
pages = "42--52",
journal = "PACE - Pacing and Clinical Electrophysiology",
issn = "0147-8389",
publisher = "Wiley-Blackwell",
number = "1 I",

}

TY - JOUR

T1 - Comparison of ramp and stepwise incremental pacing in assessment of antegrade and retrograde conduction

AU - Zhang, X.

AU - Fisher, John Devens

AU - Kim, Soo G.

AU - Matos, J. A.

AU - Waspe, L. E.

AU - Johnson, C.

PY - 1986

Y1 - 1986

N2 - Conventional assessment of antegrade (AV) and retrograde (VA) conduction involves stepwise increments in pacing rates until block in conduction is observed. This study was designed to establish the comparative characteristics of ramp pacing, in which the rate is continuously and smoothly incremented until block occurs. Two hundred and ten patients participated in portions of this study. Stepwise pacing was performed in 10 beat/minute steps, with the rate held for at least 15 seconds at each step; if marked prolongation or variability in conduction was observed, the rate was held constant for up to 60 seconds to allow for accommodation. With ramp pacing, the rate was gradually increased at a steady 2-4 beats/minute/second. Whenever possible, both stepwise and ramp pacing were performed for assessment of both antegrade and retrograde conduction. All patients had conducted sinus rhythm as their baseline mechanism. Antegrade conduction was similar using incremental stepwise and ramp pacing. The AH interval at a cycle length (CL) of 500 ms, the maximum AH increment, the cycle length at AV block were all remarkably similar (p = NS). Assessment of retrograde conduction produced similar results, with insignificant differences between maximum conducted VA intervals, and cycle length at VA block using the two pacing techniques. Ramp pacing provides a useful and rapid alternative to conventional stepwise incremental pacing in the assessment of antegrade and retrograde conduction in patients using both normal and accessory pathways. Ramp pacing was better tolerated, and some correlations between antegrade and retrograde conduction were stronger with the ramp pacing technique.

AB - Conventional assessment of antegrade (AV) and retrograde (VA) conduction involves stepwise increments in pacing rates until block in conduction is observed. This study was designed to establish the comparative characteristics of ramp pacing, in which the rate is continuously and smoothly incremented until block occurs. Two hundred and ten patients participated in portions of this study. Stepwise pacing was performed in 10 beat/minute steps, with the rate held for at least 15 seconds at each step; if marked prolongation or variability in conduction was observed, the rate was held constant for up to 60 seconds to allow for accommodation. With ramp pacing, the rate was gradually increased at a steady 2-4 beats/minute/second. Whenever possible, both stepwise and ramp pacing were performed for assessment of both antegrade and retrograde conduction. All patients had conducted sinus rhythm as their baseline mechanism. Antegrade conduction was similar using incremental stepwise and ramp pacing. The AH interval at a cycle length (CL) of 500 ms, the maximum AH increment, the cycle length at AV block were all remarkably similar (p = NS). Assessment of retrograde conduction produced similar results, with insignificant differences between maximum conducted VA intervals, and cycle length at VA block using the two pacing techniques. Ramp pacing provides a useful and rapid alternative to conventional stepwise incremental pacing in the assessment of antegrade and retrograde conduction in patients using both normal and accessory pathways. Ramp pacing was better tolerated, and some correlations between antegrade and retrograde conduction were stronger with the ramp pacing technique.

UR - http://www.scopus.com/inward/record.url?scp=0022638803&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0022638803&partnerID=8YFLogxK

U2 - 10.1111/j.1540-8159.1986.tb05360.x

DO - 10.1111/j.1540-8159.1986.tb05360.x

M3 - Article

C2 - 2419855

AN - SCOPUS:0022638803

VL - 9

SP - 42

EP - 52

JO - PACE - Pacing and Clinical Electrophysiology

JF - PACE - Pacing and Clinical Electrophysiology

SN - 0147-8389

IS - 1 I

ER -