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. 1996 Feb;75(2):165–170. doi: 10.1136/hrt.75.2.165

Drug-induced narrowing of the width of the zone of entrainment as a predictor of the subsequent non-inducibility of reentrant ventricular tachycardia after an additional dose of an antiarrhythmic drug.

Y Aizawa 1, M Chinushi 1, N Naitoh 1, A Shibata 1
PMCID: PMC484253  PMID: 8673755

Abstract

BACKGROUND: The efficacy of drugs used to treat inducible monomorphic sustained ventricular tachycardia (VT) has been assessed by investigating their ability to suppress inducibility, but the mechanism of the drug action remains to be determined. OBJECTIVES: To determine electrophysiological variables that predict inducibility, divided doses of class I antiarrhythmic drugs were given and their effects were analysed, particularly the ability of the final dose to suppress inducibility. METHODS: The excitable gap was estimated by the zone of entrainment, which was defined as the difference between the cycle length of VT and the longest paced cycle length that interrupted VT during entrainment of VT with rapid pacing at paced cycle lengths in decrements of 10 ms. The cycle length of VT, the block cycle length, and the zone of entrainment were measured in the drug free state and after intermediate and final doses of procainamide, disopyramide, cibenzoline, and mexiletine. RESULTS: Sustained monomorphic VT with a mean (SD) cycle length of 285 (43) ms was induced in 8 patients. It was entrained and interrupted at the block cycle length of 231 (31) ms. The width of the zone of entrainment was 54 (23) ms. In 8 studies VT was not inducible at final doses of procainamide in 4, cibenzoline in 1, and mexiletine in 3. In another 10 studies (procainamide in 4, disopyramide in 1, cibenzoline in 2, and mexiletine in 3), VT remained inducible at the intermediate dose and at the final dose. The cycle length of VT was prolonged to a similar degree in studies of effective and ineffective drugs, but the cycle length that blocked VT was longer at the intermediate dose of the effective drugs. Consequently, the width of the zone of entrainment was significantly narrowed at the intermediate dose of effective drugs and the width of the zone of entrainment was narrower than when ineffective drugs were given (22 (13) ms v 76 (18) or 75 (37) ms at the intermediate and final doses respectively (P < 0.02). CONCLUSION: Drugs that narrowed the zone of entrainment were associated with non-inducibility of VT after the final dose of the drug was given. The baseline variables did not predict the responses to class I antiarrhythmic drugs.

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Selected References

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  1. Aizawa M., Aizawa Y., Chinushi M., Takahashi K., Shibata A. Conductive property of the zone of slow conduction of reentrant ventricular tachycardia and its relation to pacing induced terminability. Pacing Clin Electrophysiol. 1994 Jan;17(1):46–55. doi: 10.1111/j.1540-8159.1994.tb01350.x. [DOI] [PubMed] [Google Scholar]
  2. Aizawa Y., Ebe K., Satoh M., Shibata A. Conduction through the reentrant circuit in recurrent sustained ventricular tachycardia evaluated by use of transient entrainment. Jpn Circ J. 1990 Sep;54(9):1113–1121. doi: 10.1253/jcj.54.1113. [DOI] [PubMed] [Google Scholar]
  3. Aizawa Y., Naitoh N., Washizuka T., Kitazawa H., Takahashi K., Kodama I., Shibata A. Procainamide-induced changes in reentrant ventricular tachycardia with special reference to the tachycardia-interrupting critical paced cycle length during transient entrainment with rapid pacing. Jpn Heart J. 1994 Sep;35(5):611–623. doi: 10.1536/ihj.35.611. [DOI] [PubMed] [Google Scholar]
  4. Aizawa Y., Niwano S., Chinushi M., Tamura M., Kusano Y., Miyajima T., Kitazawa H., Shibata A. Incidence and mechanism of interruption of reentrant ventricular tachycardia with rapid ventricular pacing. Circulation. 1992 Feb;85(2):589–595. doi: 10.1161/01.cir.85.2.589. [DOI] [PubMed] [Google Scholar]
  5. Almendral J. M., Rosenthal M. E., Stamato N. J., Marchlinski F. E., Buxton A. E., Frame L. H., Miller J. M., Josephson M. E. Analysis of the resetting phenomenon in sustained uniform ventricular tachycardia: incidence and relation to termination. J Am Coll Cardiol. 1986 Aug;8(2):294–300. doi: 10.1016/s0735-1097(86)80043-2. [DOI] [PubMed] [Google Scholar]
  6. Almendral J. M., Stamato N. J., Rosenthal M. E., Marchlinski F. E., Miller J. M., Josephson M. E. Resetting response patterns during sustained ventricular tachycardia: relationship to the excitable gap. Circulation. 1986 Oct;74(4):722–730. doi: 10.1161/01.cir.74.4.722. [DOI] [PubMed] [Google Scholar]
  7. Brugada J., Boersma L., Abdollah H., Kirchhof C., Allessie M. Echo-wave termination of ventricular tachycardia. A common mechanism of termination of reentrant arrhythmias by various pharmacological interventions. Circulation. 1992 May;85(5):1879–1887. doi: 10.1161/01.cir.85.5.1879. [DOI] [PubMed] [Google Scholar]
  8. Fisher J. D., Cohen H. L., Mehra R., Altschuler H., Escher D. J., Furman S. Cardiac pacing and pacemakers II. Serial electrophysiologic-pharmacologic testing for control of recurrent tachyarrhythmias. Am Heart J. 1977 May;93(5):658–668. doi: 10.1016/s0002-8703(77)80018-5. [DOI] [PubMed] [Google Scholar]
  9. Fontaine G., Guiraudon G., Frank R., Fillette F., Cabrol C., Grosgogeat Y. Surgical management of ventricular tachycardia unrelated to myocardial ischemia or infarction. Am J Cardiol. 1982 Feb 1;49(2):397–410. doi: 10.1016/0002-9149(82)90517-3. [DOI] [PubMed] [Google Scholar]
  10. Furukawa T., Rozanski J. J., Moroe K., Gosselin A. J., Lister J. W. Efficacy of procainamide on ventricular tachycardia: relation to prolongation of refractoriness and slowing of conduction. Am Heart J. 1989 Oct;118(4):702–708. doi: 10.1016/0002-8703(89)90582-6. [DOI] [PubMed] [Google Scholar]
  11. Gillis A. M., Wyse D. G., Duff H. J., Mitchell L. B. Drug response at electropharmacologic study in patients with ventricular tachyarrhythmias: the importance of ventricular refractoriness. J Am Coll Cardiol. 1991 Mar 15;17(4):914–920. doi: 10.1016/0735-1097(91)90874-9. [DOI] [PubMed] [Google Scholar]
  12. Gold R. L., Haffajee C. I., Alpert J. S. Electrophysiologic and clinical factors influencing response to class IA antiarrhythmic agents in patients with inducible sustained monomorphic ventricular tachycardia. Am Heart J. 1986 Jul;112(1):9–13. doi: 10.1016/0002-8703(86)90670-8. [DOI] [PubMed] [Google Scholar]
  13. Grant A. O., Starmer C. F., Strauss H. C. Antiarrhythmic drug action. Blockade of the inward sodium current. Circ Res. 1984 Oct;55(4):427–439. doi: 10.1161/01.res.55.4.427. [DOI] [PubMed] [Google Scholar]
  14. Hondeghem L. M., Katzung B. G. Antiarrhythmic agents: the modulated receptor mechanism of action of sodium and calcium channel-blocking drugs. Annu Rev Pharmacol Toxicol. 1984;24:387–423. doi: 10.1146/annurev.pa.24.040184.002131. [DOI] [PubMed] [Google Scholar]
  15. Horowitz L. N., Josephson M. E., Kastor J. A. Intracardiac electrophysiologic studies as a method for the optimization of drug therapy in chronic ventricular arrhythmia. Prog Cardiovasc Dis. 1980 Sep-Oct;23(2):81–98. doi: 10.1016/0033-0620(80)90006-7. [DOI] [PubMed] [Google Scholar]
  16. Inoue H., Yamashita T., Nozaki A., Sugimoto T. Effects of antiarrhythmic drugs on canine atrial flutter due to reentry: role of prolongation of refractory period and depression of conduction to excitable gap. J Am Coll Cardiol. 1991 Oct;18(4):1098–1104. doi: 10.1016/0735-1097(91)90773-3. [DOI] [PubMed] [Google Scholar]
  17. Josephson M. E., Horowitz L. N., Farshidi A., Kastor J. A. Recurrent sustained ventricular tachycardia. 1. Mechanisms. Circulation. 1978 Mar;57(3):431–440. doi: 10.1161/01.cir.57.3.431. [DOI] [PubMed] [Google Scholar]
  18. Josephson M. E., Horowitz L. N., Spielman S. R., Waxman H. L., Greenspan A. M. Role of catheter mapping in the preoperative evaluation of ventricular tachycardia. Am J Cardiol. 1982 Jan;49(1):207–220. doi: 10.1016/0002-9149(82)90295-8. [DOI] [PubMed] [Google Scholar]
  19. Kay G. N., Epstein A. E., Plumb V. J. Preferential effect of procainamide on the reentrant circuit of ventricular tachycardia. J Am Coll Cardiol. 1989 Aug;14(2):382–390. doi: 10.1016/0735-1097(89)90190-3. [DOI] [PubMed] [Google Scholar]
  20. Kay G. N., Epstein A. E., Plumb V. J. Resetting of ventricular tachycardia by single extrastimuli. Relation to slow conduction within the reentrant circuit. Circulation. 1990 May;81(5):1507–1519. doi: 10.1161/01.cir.81.5.1507. [DOI] [PubMed] [Google Scholar]
  21. Kuchar D. L., Rottman J., Berger E., Freeman C. S., Garan H., Ruskin J. N. Prediction of successful suppression of sustained ventricular tachyarrhythmias by serial drug testing from data derived at the initial electrophysiologic study. J Am Coll Cardiol. 1988 Oct;12(4):982–988. doi: 10.1016/0735-1097(88)90465-2. [DOI] [PubMed] [Google Scholar]
  22. Kus T., Costi P., Dubuc M., Shenasa M. Prolongation of ventricular refractoriness by class Ia antiarrhythmic drugs in the prevention of ventricular tachycardia induction. Am Heart J. 1990 Oct;120(4):855–863. doi: 10.1016/0002-8703(90)90201-8. [DOI] [PubMed] [Google Scholar]
  23. Marchlinski F. E., Buxton A. E., Vassallo J. A., Waxman H. L., Cassidy D. M., Doherty J. U., Josephson M. E. Comparative electrophysiologic effects of intravenous and oral procainamide in patients with sustained ventricular arrhythmias. J Am Coll Cardiol. 1984 Dec;4(6):1247–1254. doi: 10.1016/s0735-1097(84)80145-x. [DOI] [PubMed] [Google Scholar]
  24. Morady F., Kou W. H., Schmaltz S., Annesley T., De Buitleir M., Nelson S. D., Kushner J. A. Pharmacodynamics of intravenous procainamide as used during acute electropharmacologic testing. Am J Cardiol. 1988 Jan 1;61(1):93–98. doi: 10.1016/0002-9149(88)91311-2. [DOI] [PubMed] [Google Scholar]
  25. Naccarelli G. V., Zipes D. P., Rahilly G. T., Heger J. J., Prystowsky E. N. Influence of tachycardia cycle length and antiarrhythmic drugs on pacing termination and acceleration of ventricular tachycardia. Am Heart J. 1983 Jan;105(1):1–5. doi: 10.1016/0002-8703(83)90269-7. [DOI] [PubMed] [Google Scholar]
  26. Okumura K., Olshansky B., Henthorn R. W., Epstein A. E., Plumb V. J., Waldo A. L. Demonstration of the presence of slow conduction during sustained ventricular tachycardia in man: use of transient entrainment of the tachycardia. Circulation. 1987 Feb;75(2):369–378. doi: 10.1161/01.cir.75.2.369. [DOI] [PubMed] [Google Scholar]
  27. Schmitt C. G., Kadish A. H., Marchlinski F. E., Miller J. M., Buxton A. E., Josephson M. E. Effects of lidocaine and procainamide on normal and abnormal intraventricular electrograms during sinus rhythm. Circulation. 1988 May;77(5):1030–1037. doi: 10.1161/01.cir.77.5.1030. [DOI] [PubMed] [Google Scholar]
  28. Spielman S. R., Schwartz J. S., McCarthy D. M., Horowitz L. N., Greenspan A. M., Sadowski L. M., Josephson M. E., Waxman H. L. Predictors of the success or failure of medical therapy in patients with chronic recurrent sustained ventricular tachycardia: a discriminant analysis. J Am Coll Cardiol. 1983 Feb;1(2 Pt 1):401–408. doi: 10.1016/s0735-1097(83)80066-7. [DOI] [PubMed] [Google Scholar]
  29. Stamato N. J., Rosenthal M. E., Almendral J. M., Josephson M. E. The resetting response of ventricular tachycardia to single and double extrastimuli: implications for an excitable gap. Am J Cardiol. 1987 Sep 1;60(7):596–601. doi: 10.1016/0002-9149(87)90312-2. [DOI] [PubMed] [Google Scholar]
  30. Waldo A. L., Henthorn R. W., Plumb V. J., MacLean W. A. Demonstration of the mechanism of transient entrainment and interruption of ventricular tachycardia with rapid atrial pacing. J Am Coll Cardiol. 1984 Feb;3(2 Pt 1):422–430. doi: 10.1016/s0735-1097(84)80030-3. [DOI] [PubMed] [Google Scholar]
  31. Waxman H. L., Buxton A. E., Sadowski L. M., Josephson M. E. The response to procainamide during electrophysiologic study for sustained ventricular tachyarrhythmias predicts the response to other medications. Circulation. 1983 Jan;67(1):30–37. doi: 10.1161/01.cir.67.1.30. [DOI] [PubMed] [Google Scholar]
  32. Wellens H. J. Value and limitations of programmed electrical stimulation of the heart in the study and treatment of tachycardias. Circulation. 1978 May;57(5):845–853. doi: 10.1161/01.cir.57.5.845. [DOI] [PubMed] [Google Scholar]

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