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Programmed Electrical Stimulation — EECC MCQ

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ModerateArrhythmia & ElectrophysiologyProgrammed Electrical StimulationEECC

A 60-year-old man with a history of inferior MI and LVEF 40% has monomorphic VT at 180 bpm on Holter. He is asymptomatic during the episodes. EP study is performed with programmed electrical stimulation (PES). What is the purpose of PES?

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Correct answer: B — PES assesses the inducibility of sustained VT/VF through programmed premature ventricular stimuli — inducible sustained monomorphic VT confirms a re-entrant circuit (scar-related) and supports ICD implantation for secondary prevention; it also identifies patients who may benefit from catheter ablation

Programmed electrical stimulation (PES) during EP study involves delivering premature extrastimuli (single, double, or triple) at progressively shorter coupling intervals from RV apex and outflow tract at multiple drive cycle lengths. Endpoints: (1) inducible sustained monomorphic VT (≥30 seconds or requiring termination) = positive — confirms a re-entrant arrhythmic substrate (usually scar-related), supports ICD implantation and identifies VT circuit for ablation mapping; (2) inducible VF/polymorphic VT = less specific (may occur in normal hearts with aggressive stimulation protocols); (3) no arrhythmia induced = negative (associated with lower but not zero arrhythmic risk). The 2022 ESC VA/SCD Guidelines include PES as part of risk stratification in: (1) post-MI patients with LVEF 36-50% (Class IIa — positive PES upgrades ICD consideration); (2) syncope evaluation with known structural heart disease; (3) wide-complex tachycardia diagnosis.

Reference: ESC (2022): VA/SCD Guidelines