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European Heart Journal 1983 4(2):79-85;
Copyright © 1983 by the European Society of Cardiology.
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© 1983 The European Society of Cardiology

Repetitive responses to ventricular extrastimuli: incidence and significance in patients without organic heart disease

D. ROY*, P. BRUGADA, F. W. H. M. BÄR and H. J. J. WELLENS

Department of Cardiology, University of Limburg Maastricht, The Netherlands

Received 2 December 1981; revised 26 February 1982; .

Requests for reprints to: Hein J. J. Wellens, M.D., Department of Cardiology, University of Limburg, Maastricht, The Netherlands.

Abstract

Of 110 patients without organic heart disease undergoing electrophysiological evaluation, 72 patients (65%) manifested some form of repetitive ventricular response to ventricular stimulation. In 58 (53%) bundle branch re-entry was induced and in 19 patients (17%) intraventricular re-entry. In five patients (4%) both types of repetitive responses were initiated. The indication for study was documented as ventricular tachycardia or fibrillation in 13% of the patients, supraventricular tachycardia in 51% and Wolff-Parkinson-White syndrome, syncope or conduction disturbances in the remaining patients. The incidence of clinical and inducible ventricular tachycardia or fibrillation was 8 and 2% respectively, in the group of patients manifesting only bundle branch re-entry, 37 and 32% in patients with intraventricular re-entry and 8 and 11% in patients without repetitive ventricular responses during ventricular stimulation. The predictive value of intraventricular re-entry as an indicator of severe ventricular arrhythmias was 36%.

We conclude that in our population of patients without organic heart disease, bundle branch re-entry is a frequent finding and is not related to ventricular arrhythmias, that intraventricular re-entry is less frequent and although it is associated with a higher incidence of ventricular tachycardia or fibrillation, it is a poor predictor of these arrhythmias in this study population.

Key Words: Programmed electrical stimulation of the heart • repetitive ventricular responses


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