Demonstration of the proarrhythmic preconditioning of single premature extrastimuli by use of the magnitude, phase, and distribution of repolarization alternans

Circulation
Sanjiv M NarayanJ M Smith

Abstract

We hypothesized that single premature extrastimuli (S(2)) insufficient to induce reentry produce proarrhythmic effects (proarrhythmic preconditioning) that are measurable by use of the magnitude, phase, and temporal distribution of repolarization alternans (RPA; alternate-beat fluctuations in ECG repolarization). Before programmed electrical stimulation (PES), surface ECG leads I, aVF, and V(1) were recorded in 30 patients during simultaneous atrial and ventricular pacing at 500 ms with S(2) coupling intervals (CIs) decreasing from 400 to 240 ms in 20-ms steps. We determined RPA magnitude (V(alt)) as the 0.5-cycle/beat peak after spectral decomposition of consecutive STU intervals over 64 beats immediately preceding and following each S(2), RPA phase reversals as discontinuities in the even/odd phase of STU alternation, and RPA distribution as the time point of median RPA magnitude within repolarization. Eighteen patients were induced into ventricular tachycardia (VT), whereas 12 were not. Extrastimuli dynamically modulated each characteristic of RPA. S(2) augmented V(alt) in inducible (8.2+/-2.3 versus 6.2+/-1.6 microV; P=0.003) but not noninducible patients. S(2) reversed RPA phase more in inducible than in noninducible patie...Continue Reading

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Citations

Dec 12, 2012·Australasian Physical & Engineering Sciences in Medicine·Asim Dilawer BakhshiMohammad Ali Maud
Apr 27, 2005·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Sanjiv M NarayanMichael E Cain
Nov 27, 2009·American Journal of Physiology. Heart and Circulatory Physiology·Vladimir ShustermanBarry London
Jun 8, 2011·Circulation·Sanjiv M NarayanDavid E Krummen
Oct 19, 2010·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Raja J SelvarajVijay S Chauhan
Feb 22, 2012·Heart Rhythm : the Official Journal of the Heart Rhythm Society·T IkedaJ-TWAICD Investigators
Feb 4, 2009·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Sanjiv M Narayan
Sep 9, 2008·Progress in Cardiovascular Diseases·Sanjiv M Narayan
Mar 7, 2006·The American Journal of Cardiology·Sanjiv M NarayanVictor G Dávila-Román
Jul 10, 2003·IEEE Transactions on Bio-medical Engineering·David J ChristiniBruce B Lerman
Oct 20, 2004·IEEE Transactions on Bio-medical Engineering·Sanjiv M Narayan, Valmik Bhargava
Apr 14, 2005·IEEE Transactions on Bio-medical Engineering·Juan Pablo Martinez, Salvador Olmos
Aug 19, 2014·BioMed Research International·G PiccirilloD Magrì
Jan 18, 2006·Journal of the American College of Cardiology·Sanjiv M Narayan
Feb 21, 2018·IEEE Transactions on Bio-medical Engineering·Alba Martin-YebraJuan Pablo Martinez
Feb 17, 2007·Pacing and Clinical Electrophysiology : PACE·Alaa A ShalabyVladimir Shusterman
Oct 14, 2005·Pacing and Clinical Electrophysiology : PACE·Sanjiv M NarayanMichael E Cain
Sep 13, 2014·Circulation Journal : Official Journal of the Japanese Circulation Society·Gautam LalaniSanjiv M Narayan
Mar 7, 2019·Journal of Endocrinological Investigation·G PiccirilloA Aversa
Nov 28, 2017·Cardiac Electrophysiology Clinics·Basil SaourClyde W Yancy

Related Concepts

Cardiac Arrhythmia
Electric Stimulation Technique
Electrocardiographic Recorders
Tachycardia, Ventricular
Ischemic Preconditioning, Myocardial

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