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Journal CME/HeartRhythm Journal: December 2016 Vol. 13, Issue 12: Entrainment of Ventricular Tachycardia: Is the Pacing Site In or Out?

Activity Type:

  • Journal CME

Release Date: 11/22/2016

Expiration Date: 11/21/2018

  • CME: 1


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Journal CME/HeartRhythm Journal
December 2016 Volume 13, Issue 12

A 77-year-old man with history of ischemic cardiomyopathy with an ejection fraction of 35% was referred for ablation of recurrent VT.  Electroanatomic mapping of the epicardium revealed apical scar during RV pacing, with focal activation during VT, originating from the apex. Endocardial mapping confirmed the extensive dense scar extending from the base toward the apex along the anteroseptal wall.  Within the more apical portion of the scar, there was a localized region with late potentials and split electrograms.

The clinical VT was induced by endocardial pacing within the anteroseptal scar and was hemodynamically tolerated.  Overdrive pacing was performed to assess the response to entrainment with a multielectrode catheter that recorded local diastolic activity.  Is the pacing site in or out of the reentrant circuit?

Andrew Beaser, MD
Kelvin Chua, MD
Gaurav Upadhyay, MD
Roderick Tung, MD, FHRS



Learning Objectives

After reading the article in the HeartRhythm Journal and completing this activity, the learner will be able to: 

  • Apply entrainment principles to identify optimal sites for ablation of scar-related ventricular tachycardia
  • Demonstrate understanding of the various entrainment responses for reentrant VT
  • Recognize atypical responses to entrainment based on differentiating near-field and far-field local electrogram capture

Target Audience

This activity is designed for all professionals who participate in the care and management of heart rhythm disorders.


The Heart Rhythm Society designates this journal-based CME activity for a maximum of AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.  The method of participation is online/electronic only.

The Heart Rhythm Society is accredited by the Accreditation Council for Continuing Medical  Education (ACCME) to provide continuing medical education for physicians.

Other info


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CME Information

The Heart Rhythm Society is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.The Heart Rhythm Society designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™.

Physicians should claim only the credit commensurate with the extent of their participation in the activity.

American Academy of Nurse Practitioners 
American Academy of Nurse Practitioners (AANP) accepts AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.

American Academy of Physician Assistants 
American Academy of Physician Assistants (AAPA) accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.

American Nurses Credentialing Center 
American Nurses Credentialing Center (ANCC) accepts AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.

Contact Hours for Non-Physicians 
The Heart Rhythm Society has approved this activity for 1 contact hour for non-physicians.

It is the policy of the Heart Rhythm Society to ensure balance, independent objectivity, and scientific rigor in all its certified educational activities. Everyone involved in the planning and participation of continuing medical education activities is required to disclose any real or apparent conflicts of interest related to the content in his/her presentation(s) and also disclose discussions of unlabeled/unapproved uses of drugs or devices during his/her presentation(s).

Planners -
Lori Monteleone

Brianna Gallagher

Andrew Hill

Reviewers -
Peter Aziz, MD

Mark Link, MD

Marcie G. Berger, MD

Gopi Dandamudi, MD, FHRS
A ‐ Compensation for Services; Boehringer Ingelheim, Biosense Webster, Inc.,Medtronic, Inc..

Mitchell N. Faddis, MD, PhD 
I ‐ Research Grants; Stereotaxis, Inc.,Medtronic, Inc., St. Jude Medical
J ‐ Fellowship Support; Biotronik, Boston Scientific Corp., Medtronic, Inc., St. Jude Medical.

Donna L. Gerity, BSN, MSN, FHRS, CCDS

Taya V. Glotzer, MD, FHRS
A ‐ Compensation for Services; Medtronic, Inc., St. Jude Medical
B ‐ Speaker's Bureau; Medtronic, Inc., St. Jude Medical.

Christine M. Albert, MD, MPH
I ‐ Research Grants; St. Jude Medical, American Heart Association, NIH.

Content Development
All Heart Rhythm Society content--from objectives to content development, evaluation and measuring outcomes--is developed in compliance with ACCME guidelines. The Society’s education content is developed by expert physicians and vetted through the Education Committee to ensure alignment with organization strategic goals and that content is appropriate. Content is then reviewed by the CME Subcommittee to ensure quality and balance. HRS deploys a standard content validation form that must be signed by reviewers that states the content has been reviewed and approved.

Heart Rhythm Society takes steps to assure its learners and the public that the content of certified activities is accurate and reliable. The following principles are applied to the process of validating CME content. The content is peer-reviewed to ensure the following:

  • Fair Balance - that content is balanced among various options available for treatment and not biased toward a particular product or manufacturer.
  • Patient Treatment Recommendations - that patient treatment recommendations contained in the content are evidence-based, are appropriate for the target audience, and that the patient treatment recommendations contribute to overall improvement in patient care.
  • Scientific Validity - that scientific studies cited in the activity conform to standards accepted by the scientific community.
  • Learning Objectives - that the educational content supports the learning objectives of the activity, and that the objectives stated for performance-in-practice are actionable and measurable.
  • Omission and Commission - are there any studies, data, or best evidence that is missing?

CME Mission Statement
The Heart Rhythm Society CME Mission provides a framework for guiding and conducting the organization’s CME program and its educational activities. The CME Mission is clearly aligned with the Organizational Mission. The CME Mission Statement consists of six essential elements: purpose, scope, target audience, content, types of activities, and expected results. The purpose and scope of the Heart Rhythm Society CME Mission is to provide academically rigorous learning through the use of innovative teaching methods and advanced technologies that will enhance the ability of heart rhythm specialists worldwide to provide excellent patient care throughout their careers. The target audience is primarily heart rhythm physician specialists, but also includes scientists and other healthcare professionals who are dedicated to the study and management of heart rhythm disorders. The content covers any topic that addresses disturbances of the heart's rhythm or electrical activation, including the diagnosis, treatment, and prevention of bradyarrhythmias, tachyarrhythmias, sudden death, and cardiac dysfunction associated with electrophysiologic abnormalities. Emphasis will be placed on education designed to improve quality of life and survival for patients.

To accomplish the CME Mission, the Heart Rhythm Society currently develops the following types of educational activities:

  • Educational courses and symposia, including didactic presentations, interactive computer sessions and workshops;
  • Enduring materials, including audiotapes, CD-ROMs, and Webcasts;
  • Activities, such as those listed above, developed through collaboration with other medical organizations, in compliance with the ACCME Essentials and Standards

Expected results include improved knowledge and understanding resulting in improvements in health care provider competence, performance, or patient outcomes. Whenever possible, educational activities will be designed to address gaps in performance as compared to accepted performance measures or benchmarks determined by expert consensus and based upon scientific evidence. Evaluation of changes in behavior as a result of educational interventions will help guide future initiatives.

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