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Site-Specific Ventricular Tachycardia Inducibility
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  • Asad Aboud,
  • Robert Abraham,
  • oluwaseun adeola,
  • Ikutaro Nakajima,
  • Ryohsuke Narui,
  • Tomofumi Nakamura,
  • Arvindh Kanagasundram,
  • Travis Richardson,
  • William Stevenson
Asad Aboud
Vanderbilt University Medical Center
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Robert Abraham
Vanderbilt University Medical Center
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oluwaseun adeola
Vanderbilt University Medical Center
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Ikutaro Nakajima
Saint Marianna University School of Medicine
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Ryohsuke Narui
The Jikei University School of Medicine
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Tomofumi Nakamura
Tokyo Metropolitan Toshima Hospital
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Arvindh Kanagasundram
Vanderbilt University Medical Center
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Travis Richardson
Vanderbilt University Medical Center
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William Stevenson
Vanderbilt Heart and Vascular Institute
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Abstract

Introduction Programmed electrical stimulation is an essential part of VT ablation procedures but VT is not always inducible, usually for reasons that are not clear. We sought to review pacing site-specific failure of programmed electrical stimulation (PES) to induce scar-related ventricular tachycardia (VT). Methods A series of patients in whom aggressive programmed stimulation from traditional RV pacing sites failed to induce VT, but VT was easily inducible from a non-traditional site are reviewed. Computer simulations in a simple 2-dimensional model of reentry were performed. Results Six patients who had no inducible sustained VT from the RV apex/outflow tract with at least 3 extrastimuli, but relatively easily induced VT from the LV, basal RV, epicardium, or atrium are described. In 5 of these patients, the site that induced VT was closer to the likely reentry circuit region based on mapping and ablation. Computer simulations illustrated that the spatial relation between the pacing site and the entrance and exits of a reentry isthmus can determine the ease of initiation of reentry by determining the time available for recovery of excitability at the initial region of block. Conclusions The site of PES has a marked effect on inducibility of VT in some patients such that PES from the RV apex and outflow regions will fail to expose clinically relevant VTs. The frequency with which this occurs is not certain. Stimulation from alternative sites is a reasonable consideration in selected patients.