Importance of the pacing mode in the initiation of ventricular tachyarrhythmia in a canine model of chronic myocardial infarction

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Abstract

The use of unipolar anodal or bipolar pacing, as compared with unipolar cathodal pacing, purportedly increases the likelihood of inducing inadvertent ventricular fibrillation in susceptible patients. In this study, the ability to initiate sustained ventricular tachycardia or fibrillation with unipolar cathodal, unipolar anodal and bipolar pacing modes was compared using programmed ventricular stimulation at 82 subendocardial periinfarction sites in 11 dogs with chronic myocardial infarction. The late diastolic excitability threshold was significantly higher and the ventricular refractory period was significantly shorter (p < 0.001) with anodal pacing (mean 0.62 mA, 156 ms, respectively) than with pacing in either the cathodal (0.12 mA, 174 ms) or the bipolar (0.13 mA, 173 ms) mode. At a current intensity twice that of the excitability threshold, the introduction of one or two extrastimuli induced ventricular tachycardia and ventricular fibrillation comparably among the three pacing modes. However, when three extrastimuli were used, ventricular fibrillation was induced with anodal pacing twice as frequently (50 [61%] of 82 sites) as with either of the other two pacing modes (each 23 [28%] of 82 sites, p < 0.001), whereas the induction of ventricular tachycardia remained comparable with anodal pacing (15 [18%] of 82 sites) and cathodal and bipolar pacing (each 14 [17%] of 82 sites). Furthermore, a similarly high incidence of inducibility of ventricular fibrillation was observed with both cathodal pacing (56 [68%] of 82 sites) and bipolar pacing (40 [49%] of 82 sites) when an increased current equal to twice the anodal excitability threshold (1.23 mA) was used. This high incidence was related to the ability to introduce extrastimuli earlier in ventricular diastole. Thus, at comparably high levels of pacing current, the initiation of ventricular fibrillation was just as likely with unipolar cathodal or bipolar pacing as with unipolar anodal stimulation. Shortening of refractoriness with increasingly higher currents appeared to be an important contributory mechanism. Conversely, pacing from normal sites with low excitability thresholds using either cathodal or bipolar stimulation minimized the risk of inadvertent ventricular fibrillation. © 1985, American College of Cardiology Foundation. All rights reserved.

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Mitamura, H., Ohm, O. J., Michelson, E. L., Sauermelch, C., & Dreifus, L. S. (1985). Importance of the pacing mode in the initiation of ventricular tachyarrhythmia in a canine model of chronic myocardial infarction. Journal of the American College of Cardiology, 6(1), 99–103. https://doi.org/10.1016/S0735-1097(85)80259-X

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