Premature excitation and onset of reentrant ventricular tachycardia

It was hypothesized that quantitative sinus rhythm electrogram measurements could be used to predict conduction events that result from premature stimulation and reentrant ventricular tachycardia inducibility. Sinus rhythm activation and electrogram-duration maps were constructed from bipolar electrograms acquired at 196-312 sites in the epicardial border zone of 43 canine hearts (25 with and 18 without reentrant ventricular tachycardia inducible by premature stimulation). From these maps, lines of electrical discontinuity, where blocks would occur during premature excitation, were estimated. The mean error in distance between the estimated and actual block lines of premature excitation was 0.97+/-0.49 cm. Based on the quantitative characteristics of the activation and electrogram-duration maps and the longest block line that formed during premature excitation, it was possible to predict whether reentry would occur (sensitivity, 94.7%; specificity, 79.6%). In reentry experiments, the breakthrough-point location along the unidirectional arc of the block that initiated reentry was also predictable (mean error, 0.79+/-0.19 cm). Sinus rhythm measurements are useful to predict conduction events that result from premature stimulation and reentry inducibility.