Programmed Ventricular Stimulation in Patients With Coronary Artery Disease

Background. This study compared the sensitivity, specificity, and efficiency of a "conventional" and "accelerated" programmed stimulation protocol in 293 patients with coronary artery disease who had a history of sustained or nonsustained monomorphic ventricular tachycardia (VT). Methods and Results. In the conventional protocol, one and two extrastimuli were introduced during sinus rhythm and during basic drive trains at cycle lengths of 600 and 400 msec at the right ventricular apex and then at the outflow tract or septum. In the accelerated protocol, one, two, and then three extrastimuli were introduced at each of three basic drive train cycle lengths (350, 400, and 600 msec) at the right ventricular apex; the procedure was repeated at a second right ventricular site. Six hundred thirty-four electrophysiological tests were performed using one of these two protocols either in the baseline state (293 tests) or during drug testing (341 tests). The yield of sustained, monomorphic VT was 89%1 with the conventional protocol and 92% with the accelerated protocol during baseline tests in patients who had a history of sustained VT (p=0.5); 20% and 34%, respectively, during baseline tests in patients with a history of nonsustained VT (p=0.06); and 701% and 77%, respectively, during drug testing (p=0.2). To induce sustained, monomorphic VT, 10.1±5.0 (mean± SD) protocol steps and 14.4± 8.7 minutes were required with the conventional protocol, compared with 4.0±3.7 steps and 5.6±6.1 minutes with the accelerated protocol (p<0.001 for each comparison). Among the tests in which sustained, monomorphic VT