COMPARISON OF BURST PACING, AUTODECREMENTAL (RAMP) PACING, AND UNIVERSAL PACING FOR TERMINATION OF VENTRICULAR-TACHYCARDIA

This study was designed to test the comparative efficacy of burst paci ng, autodecremental (ramp) pacing, and universal (steep ramp) pacing f or termination of ventricular tachycardia. A prospective, randomized s equence cross-over design was used to achieve comparisons of the pacin g modalities that were matched for patient, day, and ventricular tachy cardia characteristics. Thirty eight patients were enrolled, whose ven tricular tachycardia was well-enough tolerated to be reinduced, and te sted with 3 pacing modalities, There were 27 series 1 patients in whic h the pacing modalities were nonsynchronized burst pacing, synchronize d burst pacing, and ramp pacing, The 11 patients in series 2 were test ed with synchronized burst pacing, ramp pacing, and universal pacing, All pacing methods proved to be comparable in their ability to termina te ventricular tachycardia (P = NS). The 2 burst methods required the fewest number of attempts (significant vs ramp pacing), Universal paci ng required the fewest number of stimuli. The mean paced cycle length was similar will all methods, The shortest paced cycle lengths were fo und with the autodecremental and universal methods because of their ra mp patterns, It is concluded that burst, ramp, and universal pacing ar e of similar efficacy, although ramps were least efficient. Choice of a modality depends on operator preference, and individual patient resp onse.