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A Prospective Study of Changes in Right Ventricular dP/dt During Ventricular Tachycardia
Author(s) -
KAPADIA KETAN A.,
WOOD MARK A.,
LU BIN,
VALENTA HARRY,
ELLENBOGEN KENNETH A.
Publication year - 1991
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1991.tb02840.x
Subject(s) - medicine , cardiology , ventricular tachycardia , heart rate , blood pressure , tachycardia , supraventricular tachycardia
The automatic implantabie cardioverter defibrillator (AICD) has significantly decreased mortality in high risk ventricular tachycardia (VT) patients. The AICD provides treatment based on ventricular rate, sometimes leading to high energy shocks in conscious patients with stable VT, or patients with sinus or supraventricular tachycardia. Other physiological parameters, such as maximal positive and negative systolic right ventricular (RV) dP/dt (RV +dP/df max , RV ‐dP/dt max , respectively), may be included in detection algorithms for future implantabie defibrillators. We studied frequency band limited positive and negative RV dP/dt max before, during, and after 13 episodes of VT lasting at least 40 beats in duration in nine male patients. The mean (± SEM) RV + dP/dt max , dropped by 120 ± 28 mmHg/sec (P < 0.001) during the first five beats of VT. RV +dP/dt max then slowly rose toward baseline levels until a significant overshoot occurred during the first ten beats following VT termination (δ= 234 ± 58 mmHg/second, P < 0.002). RV +dP/dt max correlated poorly with mean arterial pressure (r = 0.32, P > 0.1), systolic blood pressure (r = 0.19, P > 0.1), and VT cycle length (r == 0.34, P > 0.1). Conversely, RV ‐ dP/dt max rose during the first ten beats of VT (74 ± 27 mmHg/sec, P > 0.05) and then slowly drifted back toward baseline levels. Like RV + dP/dt max , RV ‐dP/df max overshot baseline levels during the recovery phase (‐ 108 ± 48 mmHg/sec, P < 0.05). RV ‐dP/dt max also did not correlate well with mean arterial pressure (r = 0.06, P > 0.1), systolic blood pressure (r = 0.077. P > 0.1), or VT cycle length (r = 0.064, P > 0.1), We conclude that frequency band limited measurement of positive and negative RV dP/dt max poorly reflect hemodynamic stability during VT and would probably not be useful as a hemodynamic sensor in AICDs.