Role of papillary muscle in the generation and maintenance of reentry during ventricular tachycardia and fibrillation in isolated swine right ventricle

被引:135
作者
Kim, YH
Xie, FG
Yashima, M
Wu, TJ
Valderrábano, M
Lee, MH
Ohara, T
Voroshilovsky, O
Doshi, RN
Fishbein, MC
Qu, ZL
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, Div Cardiol, Los Angeles, CA USA
[3] Univ Calif Los Angeles, Sch Med, Dept Physiol, Div Cardiol, Los Angeles, CA USA
[4] Univ Calif Los Angeles, Sch Med, Dept Physiol Sci, Div Cardiol, Los Angeles, CA USA
[5] Univ Calif Los Angeles, Sch Med, Dept Pathol, Div Cardiol, Los Angeles, CA USA
[6] Korea Univ, Seoul 136701, South Korea
关键词
death; sudden; electrophysiology; waves; procainamide; antiarrhythmia agents;
D O I
10.1161/01.CIR.100.13.1450
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-The role of papillary muscle (PM) in the generation and maintenance of reentry is unclear. Methods and Results-Computerized mapping (477 bipolar electrodes, 1.6-mm resolution) was performed in fibrillating right ventricles (RVs) of swine in vitro. During ventricular fibrillation (VF), reentrant wave fronts often transiently anchored to the PM. Tissue mass reduction was then performed in 10 RVs until VF converted to ventricular tachycardia (VT), In an additional 6 RVs, procainamide infusion converted VF to VT. Maps showed that 77% (34 of 44) of all VT episodes were associated with a single reentrant wave front anchored to the PM. Purkinje fiber potentials preceded the local myocardial activation, and these potentials were recorded mostly around the PM. When PM was trimmed to the level of endocardium (n = 4), sustained VT was no longer inducible, Transmembrane potential recordings (n = 5) at the PM revealed full action potential during pacing, without evidence of ischemia, Computer simulation studies confirmed the role of PM as a spiral wave anchoring site that stabilized wave conduction. Conclusions-We conclude that PM is important in the generation and maintenance of reentry during VT and VF.
引用
收藏
页码:1450 / 1459
页数:10
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