Arrhythmogenesis by single ectopic beats originating in the Purkinje system.

American Journal of Physiology. Heart and Circulatory Physiology
M DeoE J Vigmond

Abstract

Cells in the Purkinje system (PS) are known to be more vulnerable than ventricular myocytes to secondary excitations during the action potential (AP) plateau or repolarization phases, known as early afterdepolarizations (EADs). Since myocytes have a lower intrinsic AP duration than the PS cells to which they are coupled, EADs occurring in distal branches of the PS are more likely to result in propagating ectopic beats. In this study, we use a computer model of the rabbit ventricles and PS to investigate the consequences of EADs occurring at different times and places in the cardiac conduction system. We quantify the role of tissue conductivity and excitability, as well as interaction with sinus excitation, in determining whether an EAD-induced ectopic beat will establish reentrant activity. We demonstrate how a single ectopic beat arising from an EAD in the distal PS can give rise to reentrant arrhythmia; in contrast, EADs in the proximal PS were unable to initiate reentry. Clinical studies have established the PS as a potential substrate for reentry, but the underlying mechanisms of these types of disorder are not well understood, nor are conditions leading to their development clearly defined; this work provides new insights ...Continue Reading

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Citations

Feb 27, 2013·Proceedings of the National Academy of Sciences of the United States of America·Makarand DeoSilvia G Priori
Oct 11, 2011·American Journal of Physiology. Heart and Circulatory Physiology·Chengzong HanBin He
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