Should protocol of programmed ventricular stimulation be adapted to each patient?
Brembilla-Perrot, B.; Houplon, P.; Jacquemin, L.; Lemoine, C.; Mathieu, P.
Archives des Maladies du Coeur et des Vaisseaux 89(11): 1413-1416
1996
ISSN/ISBN: 0003-9683 PMID: 9092400 Document Number: 469276
The authors report the case of a 56 year old patient in whom the mechanisms of a wide QRS complex tachycardia recorded on an intensive care monitor could not be determined. The patient also had episodes of atrial flutter with left bundle branch block. Programmed ventricular stimulation with 3 extrastimuli triggered a non-specific ventricular flutter. One week later, the patient was resuscitated from a cardiac arrest which was undocumented. It was therefore important to elucidate the mechanism of the initial tachycardia. A second session of programmed ventricular stimulation was undertaken. As the use of 2 extrastimuli triggered runs of unsustained polymorphic ventricular tachycardia, the classical protocol was stopped. An infusion of low-dose isoproterenol was used to repeat programmed stimulation with a single extrastimulus. This protocol triggered sustained monomorphic ventricular tachycardia at 240/min. The diagnosis of ventricular tachycardia could therefore be continued.