Programmed electrical stimulation of the ventricle: An efficient, sensitive, and specific protocol

John Devens Fisher, Soo G. Kim, Kevin J. Ferrick, S. G. Artoul, D. Fink, J. A. Roth, D. R. Johnston, H. R. Williams

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

A relatively simple and efficient ventricular programmed electrical stimulation (PES) protocol was developed, capable of achieving high degrees of sensitivity and specificity. In a series of 481 subjects, 1, 2, and 3 extrastimuli (ES) were used successively during sinus rhythm and ventricular pacing at two drive cycle lengths, at one or more ventricular sites, together with rapid ventricular pacing, and other maneuvers such as isoproterenol infusion. Three ES were used immediately after two ES at each drive rate, rather than returning after completion of the protocol with two ES. Using the protocol, appropriate arrhythmias could be induced in 88% of all patients with ventricular fibrillation, 84% of all patients with sustained ventricular tachycardia (91% with underlying coronary disease), and 58% of patients with severe nonsustained ventricular tachycardia. There were significant differences in inducibility between patients whose ventricular arrhythmias were due to coronary artery disease and other causes. In contrast, sustained ventricular arrhythmias (all ventricular fibrillation) could be induced in only 5% of a control group of control patients, for a specificity of 95%. The protocol described is simpler and more efficient than those that use exhaustive testing of two ES before going to three ES. Three ES during sinus rhythm proved to be the most productive step, with a higher yield ratio (true: false-positives) than two ES or three ES during pacing, especially at faster rates. Greater efficiency is also achieved by leaving the timing of an extrastimulus just beyond its effective refractory period when an additional extrastimulus is to be added, compared to protocols in which the extrastimulus is moved later in the cycle and then decremented in tandem with the additional extrastimulus. Coupling intervals < 200 msec produced some false-positives, but fewer overall than intervals ≥ 200 msec, and with yield ratios comparable to other protocol steps. The protocol described meets NASPE standards for ventricular programmed stimulation protocols, and with its demonstrated specificity and relative simplicity and efficiency may be useful as a model for groups not yet committed to an alternative protocol.

Original languageEnglish (US)
Pages (from-to)435-450
Number of pages16
JournalPACE - Pacing and Clinical Electrophysiology
Volume15
Issue number4 I
DOIs
StatePublished - 1992

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Electric Stimulation
Cardiac Arrhythmias
Ventricular Fibrillation
Ventricular Tachycardia
Isoproterenol
Coronary Disease
Coronary Artery Disease
Sensitivity and Specificity
Control Groups

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Programmed electrical stimulation of the ventricle : An efficient, sensitive, and specific protocol. / Fisher, John Devens; Kim, Soo G.; Ferrick, Kevin J.; Artoul, S. G.; Fink, D.; Roth, J. A.; Johnston, D. R.; Williams, H. R.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 15, No. 4 I, 1992, p. 435-450.

Research output: Contribution to journalArticle

Fisher, John Devens ; Kim, Soo G. ; Ferrick, Kevin J. ; Artoul, S. G. ; Fink, D. ; Roth, J. A. ; Johnston, D. R. ; Williams, H. R. / Programmed electrical stimulation of the ventricle : An efficient, sensitive, and specific protocol. In: PACE - Pacing and Clinical Electrophysiology. 1992 ; Vol. 15, No. 4 I. pp. 435-450.
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