Spatiotemporal heterogeneity in the induction of ventricular fibrillation by rapid pacing importance of cardiac restitution properties

被引:194
作者
Cao, JM
Qu, ZL
Kim, YH
Wu, TJ
Garfinkel, A
Weiss, JN
Karagueuzian, HS
Chen, PS
机构
[1] Cedars Sinai Med Ctr, Dept Med, Div Cardiol, Los Angeles, CA 90048 USA
[2] Univ Calif Los Angeles, Sch Med, Dept Med Cardiol, Los Angeles, CA 90024 USA
[3] Univ Calif Los Angeles, Sch Med, Dept Physiol, Los Angeles, CA 90024 USA
[4] Univ Calif Los Angeles, Sch Med, Dept Physiol Sci, Los Angeles, CA 90024 USA
关键词
D O I
10.1161/01.RES.84.11.1318
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The mechanism by which rapid pacing induces ventricular fibrillation (VF) is unclear. We performed computerized epicardial mapping studies in 10 dogs, using 19-beat pacing trains. The pacing interval (PI) of the first train was 300 ms and then was progressively shortened until VF was induced. For each PI, we constructed restitution curves for the effective refractory period (ERP). When the PI was long, the activation cycle length (CL) was constant throughout the mapped region. However, as the PI shortened, there was an increase in the spatiotemporal complexity of the CL variations and an increase in the slope of the ERP restitution curve. In 5 dogs, we documented the initiation of VF by wavebreak at the site of long-short CL variations. Computer simulation studies using the Luo-Rudy I ventricular action potential model in simulated 2-dimensional tissue reproduced the experimental results when normal ERP and conduction velocity (CV) restitution properties were intact. By altering CV and ERP restitutions in this model, we found that CV restitution creates spatial CL variations, whereas ERP restitution underlies temporal, beat-to-beat variations in refractoriness during rapid pacing. Together, the interaction of CV and ERP restitutions produces spatiotemporal oscillations in cardiac activation that increase in amplitude as the PI decreases, ultimately causing wavebreak at the site of intrinsic heterogeneity. This initial wavebreak then leads to the formation of spiral waves and VF. These findings support a key role for both CV and ERP restitutions in the initiation of VF by rapid pacing.
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页码:1318 / 1331
页数:14
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