Mechanism linking T-wave alternans to the genesis of cardiac fibrillation

Circulation
Joseph M PastoreDavid S Rosenbaum

Abstract

Although T-wave alternans has been closely associated with vulnerability to ventricular arrhythmias, the cellular processes underlying T-wave alternans and their role, if any, in the mechanism of reentry remain unclear. -T-wave alternans on the surface ECG was elicited in 8 Langendorff-perfused guinea pig hearts during fixed-rate pacing while action potentials were recorded simultaneously from 128 epicardial sites with voltage-sensitive dyes. Alternans of the repolarization phase of the action potential was observed above a critical threshold heart rate (HR) (209+/-46 bpm) that was significantly lower (by 57+/-36 bpm) than the HR threshold for alternation of action potential depolarization. The magnitude (range, 2.7 to 47.0 mV) and HR threshold (range, 171 to 272 bpm) of repolarization alternans varied substantially between cells across the epicardial surface. T-wave alternans on the surface ECG was explained primarily by beat-to-beat alternation in the time course of cellular repolarization. Above a critical HR, membrane repolarization alternated with the opposite phase between neighboring cells (ie, discordant alternans), creating large spatial gradients of repolarization. In the presence of discordant alternans, a small acce...Continue Reading

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Jun 26, 2007·American Journal of Physiology. Heart and Circulatory Physiology·Vladimir E Bondarenko, Randall L Rasmusson
Oct 16, 2007·American Journal of Physiology. Heart and Circulatory Physiology·Zheng I Zhu, Colleen E Clancy
Oct 30, 2014·Physical Review. E, Statistical, Nonlinear, and Soft Matter Physics·Per Sebastian SkardalJuan G Restrepo
Aug 15, 2014·Physical Review. E, Statistical, Nonlinear, and Soft Matter Physics·Felicia YapariStevan Dubljevic
Jan 15, 2002·American Journal of Physiology. Heart and Circulatory Physiology·Jeffrey J FoxRobert F Gilmour
Nov 22, 2000·American Journal of Physiology. Heart and Circulatory Physiology·M L KollerRobert F Gilmour
Aug 30, 2003·American Journal of Physiology. Heart and Circulatory Physiology·Peter SmetanaMarek Malik
Aug 17, 2005·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Olivier BernusArkady M Pertsov
Sep 12, 2006·American Journal of Physiology. Heart and Circulatory Physiology·Björn C KnollmannMichael R Franz
Jun 11, 2008·SIAM Journal on Applied Mathematics·John W Cain
Dec 15, 2010·American Journal of Physiology. Heart and Circulatory Physiology·Masahide HaradaItsuo Kodama
Dec 11, 2013·American Journal of Physiology. Heart and Circulatory Physiology·Faisal M MerchantAntonis A Armoundas
Mar 15, 2015·Physical Review. E, Statistical, Nonlinear, and Soft Matter Physics·M RadszuweitBlas Echebarria
May 6, 2017·Physical Review Letters·Diandian Diana ChenFlavio H Fenton
Sep 12, 2018·Biological cybernetics·Bharat MongaJeff Moehlis
Nov 16, 2001·American Journal of Physiology. Heart and Circulatory Physiology·K J Sampson, C S Henriquez
Apr 16, 2004·Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc·Paulus KirchhofDirk Böcker
Apr 20, 2004·Journal of Cardiovascular Electrophysiology·Isabelle BanvilleRichard A Gray
Sep 4, 2004·American Journal of Physiology. Heart and Circulatory Physiology·Vikram LakireddyNabil El-Sherif
Feb 1, 2008·Physical Review. E, Statistical, Nonlinear, and Soft Matter Physics·Blas Echebarria, Alain Karma
Nov 6, 2007·American Journal of Physiology. Heart and Circulatory Physiology·Anne Louise KjølbyeDavid S Rosenbaum
Oct 24, 2007·American Journal of Physiology. Heart and Circulatory Physiology·William T Clusin
Nov 21, 2007·American Journal of Physiology. Heart and Circulatory Physiology·Carlos de DiegoMiguel Valderrábano
Jul 1, 2018·Biological cybernetics·Bharat Monga, Jeff Moehlis
Jan 3, 2020·Chaos·Andrea J WelshFlavio H Fenton
Nov 30, 2018·Neurocritical Care·Mohammad S IbrahimKushak Suchdev
Aug 22, 2006·American Journal of Physiology. Heart and Circulatory Physiology·Norihiko OnoHrayr S Karagueuzian
Jul 31, 2007·American Journal of Physiology. Heart and Circulatory Physiology·Zhilin Qu, James N Weiss
Jun 26, 2007·American Journal of Physiology. Heart and Circulatory Physiology·Ming-Jim YangZhilin Qu
Aug 11, 2005·Physical Review. E, Statistical, Nonlinear, and Soft Matter Physics·Hervé Henry, Wouter-Jan Rappel
Oct 2, 2017·Chaos·Alejandro Garzón, Roman O Grigoriev
May 7, 2013·American Journal of Physiology. Heart and Circulatory Physiology·Rebecca M SmithElena G Tolkacheva
Nov 28, 2019·Oxford Medical Case Reports·Masahiro KashiuraTakashi Moriya
Jan 25, 2019·Environmental Health Perspectives·Zhen WangCrystal M Ripplinger
Apr 12, 2001·American Journal of Physiology. Heart and Circulatory Physiology·Kenneth R Laurita, A Singal
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Aug 9, 2003·American Journal of Physiology. Heart and Circulatory Physiology·You-Wen QianWilliam T Clusin
Dec 14, 2007·Biological Research for Nursing·Margaret B Harvey, Jack W Buchanan
Oct 10, 2020·Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology·Ricardo AvendañoYi-Hwa Liu
Aug 7, 2020·Circulation. Arrhythmia and Electrophysiology·Prasongchai SattayaprasertKenneth R Laurita

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