Abstract
When the ventricle is electrically stimulated shortly after the termination of the refractory period, a propagated depolarization occurs which does not result in a clearly defined second ventricular contraction. A technic for repetitively delivering properly spaced paired electrical stimuli to the human heart is described, and the effects of paired electrical stimulation, or of coupled pacing, in ten patients are presented. By prolonging the period of time during which the ventricles were unresponsive to other stimuli, it was possible to reduce the heart rate. Slowing the heart rate was accomplished in two patients with rapid ventricular rates, associated in one with atrial fibrillation and in the other with atrial tachycardia. Paired electrical stimulation also augmented the contractile state of the myocardium. This augmentation was evidenced by increases in the rate of rise of intraventricular pressure, the mean systolic ejection rate and the rate of myocardial shortening, and is considered to be a form of sustained postextrasystolic potentiation. However, no consistent changes in ventricular end-diastolic pressure or cardiac output occurred. The potential clinical applications of this technic are discussed.
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