Programmed Ventricular Stimulation: Risk Stratification and Guiding Antiarrhythmic Therapies.

Autor:	Markman TM; Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA., Marchlinski FE; Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA., Callans DJ; Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA., Frankel DS; Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. Electronic address: david.frankel@pennmedicine.upenn.edu.
Jazyk:	angličtina
Zdroj:	JACC. Clinical electrophysiology [JACC Clin Electrophysiol] 2024 Jul; Vol. 10 (7 Pt 1), pp. 1489-1507. Date of Electronic Publication: 2024 Apr 24.
DOI:	10.1016/j.jacep.2024.02.034
Abstrakt:	Electrophysiologic testing with programmed ventricular stimulation (PVS) has been utilized to induce ventricular tachycardia (VT), thereby improving risk stratification for patients with ischemic and nonischemic cardiomyopathies and determining the effectiveness of antiarrhythmic therapies, especially catheter ablation. A variety of procedural aspects can be modified during PVS in order to alter the sensitivity and specificity of the test including the addition of multiple baseline pacing cycle lengths, extrastimuli, and pacing locations. The definition of a positive result is also critically important, which has varied from exclusively sustained monomorphic VT (>30 seconds) to any ventricular arrhythmia regardless of morphology. In this review, we discuss the history of PVS and evaluate its role in sudden cardiac death risk stratification in a variety of patient populations. We propose an approach to future investigations that will capitalize on the unique ability to vary the sensitivity and specificity of this test. We then discuss the application of PVS during and following catheter ablation. The strategies that have been utilized to improve the efficacy of intraprocedural PVS are highlighted during a discussion of the limitations of this probabilistic strategy. The role of noninvasive programmed stimulation is also reviewed in predicting recurrent VT and informing management decisions including repeat ablations, modifications in antiarrhythmic drugs, and implantable cardioverter-defibrillator programming. Based on the available evidence and guidelines, we propose an approach to future investigations that will allow clinicians to optimize the use of PVS for risk stratification and assessment of therapeutic efficacy. Competing Interests: Funding Support and Author Disclosures This research was supported by the F. Harlan Batrus EP Research Fund and the Mark Marchlinski EP Research and Education Fund. Dr Markman has reported that he has no relationships relevant to the contents of this paper to disclose. Dr Marchlinski has received research funding from Biosense Webster; and lecture honoraria from Abbott, Boston Scientific, and Medtronic. Dr Callans has received consulting fees and lecture honoraria from Abbott, Biosense Webster, Biotronik, and Boston Scientific. Dr Frankel has received research support from Biosense Webster; and lecture honoraria from Abbott. (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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