Mechanism of pacing-induced ventricular fibrillation in the infarcted human heart

Circulation
Anthony W C ChowN S Peters

Abstract

The mechanisms by which ventricular fibrillation (VF) is initiated in the infarcted human heart have not been defined. Left ventricular noncontact mapping of 8 episodes of pacing-induced VF in 6 patients (age 64.8+/-7.9 years, with previous myocardial infraction and left ventricular ejection fraction of 36+/-4%) undergoing ventricular tachycardia (VT) ablation revealed a consistent mechanism of VF induction. Whether during VT or sinus rhythm, the first of a train of paced extrastimuli to capture the LV produced an arc or arcs of functional block at regions bordering scar. With subsequent extrastimuli, the arcs elongated to circumscribe an enlarging area of increasingly late activation, with reentry through part of this functional (unidirectional) block leading to wavefront fragmentation and VF. These regions had longer fibrillation intervals (263+/-63 ms) than remote LV regions (209+/-23.4 ms; P<0.0001), implying longer refractory periods, and in 6 of the 8 VF episodes, these regions correlated with VT exit sites. In each of the 2 patients with 2 episodes of VF, both episodes formed arcs of functional block in the same location, despite pacing from different sites. Pacing-induced VF in the infarcted human heart is initiated by ...Continue Reading

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Citations

Jan 29, 2011·Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing·Gabriel Decebal LatcuPhilippe Maury
Mar 21, 2012·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·Vern Hsen TanReginald Liew
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Aug 6, 2016·Expert Review of Cardiovascular Therapy·Jason T JacobsonWilbert Aronow
May 15, 2015·Postgraduate Medicine·Jason T JacobsonWilbert Aronow
Oct 2, 2009·Physical Review. E, Statistical, Nonlinear, and Soft Matter Physics·Trine Krogh-Madsen, David J Christini
Nov 9, 2005·Progress in Cardiovascular Nursing·Christine ThompsonAmin Al-Ahmad
Nov 18, 2010·Cardiovascular Engineering·Sharon Zlochiver

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