Effect of mexiletine on conduction of premature ventricular beats in man: a study using monophasic action potential recordings from the right ventricle.

Ventricular conduction intervals between a stimulating pacemaker electrode at the right ventricular apex and an impulse detecting monophasic action potential electrode at the right ventricular septum were measured in nine subjects. The right ventricle was paced at a constant rate and programmed premature ventricular stimuli were introduced after every eighth paced beat beginning at the refractory period. The ventricular conduction intervals were measured from the pacemaker artefact to the onset of depolarisation of the MAP recording. In the control recordings a short period of prolonged (subnormal) conduction lasting for 5 to 26 ms after the refractory period was present in six of the nine subjects. In eight subjects a period of 'supernormal' conduction lasting from 50 to 180 ms was present. The effect of mexiletine was to increase the subnormal conduction and to abolish the supernormal conduction. It is concluded that a small degree of supernormal conduction occurs in the normal human ventricle possibly as a result of phase 4 depolarisation of cells of the specialised conducting system.