Techniques of Programmed Stimulation and Entrainment Medication

Updated: Dec 30, 2021
  • Author: Ethan Levine, DO; Chief Editor: Jeffrey N Rottman, MD  more...
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Medication Summary

While not mandatory, there are several medications that may be employed during the use of programmed stimulation. The choice of agent is dictated by the clinical arrhythmia being investigated. In the case of atrioventricular (AV) nodal reentrant tachycardia (AVNRT) for example, the operator may choose to use a positive chronotropic agent such as isoproterenol to aid in inducing or sustaining the arrhythmia as well as to confirm the success of ablation. Other agents commonly employed in the electrophysiology laboratory during programmed stimulation might include beta blockade, adenosine, non-dihydropyridine calcium channel blockers, or ibutilide, as well as other medications depending on the clinical scenario.


Beta1/Beta2 Adrenergic Agonists

Isoproterenol (Isuprel)

Isoproterenol accelerates AV conduction and decreases the QT interval by increasing the heart rate and reducing temporal dispersion of repolarization.


Beta-Blockers, Beta-1 Selective

Metoprolol (Kapspargo Sprinkle, Lopressor, Toprol XL)

Metoprolol is a selective beta-1 adrenergic receptor blocker that decreases the automaticity of contractions. During intravenous administration, carefully monitor blood pressure, heart rate, and ECG.


Antidysrhythmics, V

Adenosine (Adenocard, Adenoscan)

Adenosine transiently blocks conduction through the AV node. It can interrupt reentry pathways through the AV node and restore normal sinus rhythm in paroxysmal SVT, including paroxysmal SVT associated with Wolff-Parkinson-White (WPW) syndrome. Adenosine has a short half-life. It is the preferred medication for IV administration to terminate AVNRT because of its rapid metabolism and generally good safety profile.


Antidysrhythmics, III

Ibutilide (Corvert)

Ibutilide can terminate some atria tachycardias. Ibutilide works by increasing the action potential duration and, thereby, changing atrial cycle-length variability.