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(Circulation. 1997;96:3136-3147.)
© 1997 American Heart Association, Inc.

Articles

Mechanisms for Absence of Inverse Relationship Between Coupling Intervals of Premature Impulses Initiating Reentrant Ventricular Tachycardia and Intervals Between Premature and First Tachycardia Impulses

Candido Cabo, PhD; Bernard Deruyter, MD; James Coromilas, MD; ; Andrew L. Wit, PhD

From the Departments of Pharmacology and Medicine, College of Physicians and Surgeons of Columbia University, New York, NY.

Correspondence to Andrew L. Wit, PhD, Department of Pharmacology, College of Physicians and Surgeons of Columbia University, 630 W 168th St, New York, NY 10032.

Background During initiation of tachycardias by programmed stimulation (PES), an inverse relationship between the coupling interval of the premature impulse (V₁V₂) and the interval between the premature impulse and the first impulse of tachycardia (V₂T₁) has been proposed to be a specific indicator of reentry. However, an inverse relationship has not always been observed during initiation of clinical reentrant ventricular tachycardias (VTs).

Methods and Results Reentrant VT was initiated by PES in twelve 4-day-old infarcted dog hearts. The relationship between V₁V₂ and V₂T₁ was always direct. Mapping of the epicardial border zone (EBZ) indicated that initiation of VT was secondary to functional orthodromic block of V₂, propagation of V₂ around the line of block, and antidromic propagation through the original location of the block. In 7 dogs, the line of orthodromic block and the pathway of orthodromic propagation were similar for different V₁V₂ coupling intervals. Orthodromic conduction time around the line to its distal side was longer at shorter V₁V₂ intervals, but a shorter antidromic delay in the area of unidirectional block for shorter V₁V₂ intervals, possibly reflecting small changes in the conduction pathway involving deeper layers of the EBZ, resulted in shorter V₂T₁ intervals. In the other 5 dogs, the orthodromic conduction pathway of V₂ around the line of block changed markedly, with a shorter pathway for shorter V₁V₂ intervals resulting in shorter V₂T₁ intervals.

Conclusions An inverse relationship between V₁V₂ and V₂T₁ is not a specific indicator of functional reentry.

Key Words: arrhythmia • myocardial infarction • electrophysiology • mapping • reentry • tachycardia

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