Comparison of ramp and stepwise incremental pacing in assessment of antegrade and retrograde conduction.

Conventional assessment of antegrade (AV) and retrograde (VA) conduction involves stepwise increments in pacing rates until block in conduction is observed. This study was designed to establish the comparative characteristics of ramp pacing, in which the rate is continuously and smoothly incremented until block occurs. Two hundred and ten patients participated in portions of this study. Stepwise pacing was performed in 10 beat/minute steps, with the rate held for at least 15 seconds at each step; if marked prolongation or variability in conduction was observed, the rate was held constant for up to 60 seconds to allow for accommodation. With ramp pacing, the rate was gradually increased at a steady 2-4 beats/minute/second. Whenever possible, both stepwise and ramp pacing were performed for assessment of both antegrade and retrograde conduction. All patients had conducted sinus rhythm as their baseline mechanism. Antegrade conduction was similar using incremental stepwise and ramp pacing. The AH interval at a cycle length (CL) of 500 ms, the maximum AH increment, the cycle length at AV block were all remarkably similar (p = NS). Assessment of retrograde conduction produced similar results, with insignificant differences between maximum conducted VA intervals, and cycle length at VA block using the two pacing techniques. Ramp pacing provides a useful and rapid alternative to conventional stepwise incremental pacing in the assessment of antegrade and retrograde conduction in patients using both normal and accessory pathways. Ramp pacing was better tolerated, and some correlations between antegrade and retrograde conduction were stronger with the ramp pacing technique.