Short-Lasting Episodes of Torsade de Pointes in the Chronic Atrioventricular Block Dog Model Have a Focal Mechanism, While Longer-Lasting Episodes Are Maintained by Re-Entry

JACC. Clinical Electrophysiology
Nele VandersickelAlexander V Panfilov

Abstract

This study investigated the arrhythmogenic mechanisms responsible for torsade de pointes (TdP) in the chronic atrioventricular block dog model, known for its high susceptibility for TdP. The mechanism of TdP arrhythmias has been under debate for many years. Focal activity as well as re-entry have both been mentioned in the initiation and the perpetuation of TdP. In 5 TdP-sensitive chronic atrioventricular block dogs, 56 needle electrodes were evenly distributed transmurally to record 240 unipolar local electrograms simultaneously. Nonterminating (NT) episodes were defibrillated after 10 s. Software was developed to automatically detect activation times and to create 3-dimensional visualizations of the arrhythmia. For each episode of ectopic activity (ranging from 2 beats to NT episodes), a novel methodology was created to construct directed graphs of the wave propagation and detect re-entry loops by using an iterative depth-first-search algorithm. Depending on the TdP definition (number of consecutive ectopic beats), we analyzed 29 to 54 TdP: 29 were longer than 5 beats. In the total group, 9 were NT and 45 were self-terminating. Initiation and termination were always based on focal activity. Re-entry becomes more important in ...Continue Reading

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Citations

Apr 23, 2019·Journal of Cardiovascular Electrophysiology·Marcel A G van der Heyden, Marc A Vos
May 23, 2019·Arrhythmia & Electrophysiology Review·Nabil El-SherifMohamed Boutjdir
Oct 3, 2019·Arrhythmia & Electrophysiology Review·Agnieszka SmoczynskaMarc A Vos
Jul 18, 2020·Nature Reviews. Disease Primers·Peter J SchwartzArthur A M Wilde
Sep 26, 2019·Frontiers in Physiology·Nele VandersickelAlexander V Panfilov
Sep 26, 2019·Frontiers in Cardiovascular Medicine·Joseph S Piktel, Lance D Wilson
Jan 2, 2021·American Journal of Physiology. Heart and Circulatory Physiology·Julian LandawZhilin Qu
Oct 9, 2020·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Mathilde R RivaudRuben Coronel
Mar 9, 2021·British Journal of Pharmacology·Vera LoenMarcel A G van der Heyden

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