Published online before print September 9, 2002, doi: 10.1161/01.CIR.0000031334.49170.FB
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(Circulation. 2002;106:1859.)
© 2002 American Heart Association, Inc.
Basic Science Reports |
Two Types of Ventricular Fibrillation in Isolated Rabbit Hearts
Importance of Excitability and Action Potential Duration Restitution
From the Division of Cardiology, Department of Medicine, Taichung Veterans General Hospital and Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan (T.-J.W., C.-T.T.); the Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (S.-F.L., P.-S.C.); and the Division of Cardiology, Department of Medicine, Cardiovascular Research Laboratory (J.N.W.), UCLA School of Medicine, Los Angeles, Calif.
Correspondence to Tsu-Juey Wu, MD, Division of Cardiology, Department of Medicine, Taichung Veterans General Hospital, 160, Section 3, Chung-Kang Road, Taichung, Taiwan. E-mail tjwu{at}vghtc.vghtc.gov.tw
Background— The combined effects of excitability and action potential duration (APD) restitution on wavefront dynamics remain unclear.
Methods and Results— We used optical mapping techniques to study Langendorff-perfused rabbit hearts. In protocol IA (n=10), D600 at increasing concentrations was infused during ventricular fibrillation (VF). With concentration increased to 0.5 mg/L, fast VF (dominant frequency, 19.1±1.8 Hz) was consistently converted to ventricular tachycardia (VT). However, increasing D600 further to 2.5 or 5.0 mg/L converted VT to slow VF (11.9±2.3 Hz, P=0.0011). In an additional 4 hearts (protocol IB), tetrodotoxin converted a preexisting VT to slow VF (11.0±1.4 Hz). Optical maps show wandering wavelets in fast VF, organized reentry in VT, and spatiotemporal periodicity in slow VF. In protocol II, we determined APD and conduction time-1 (CT-1) restitutions during D600 infusion. CT-1 was used as an estimate of excitability. At 0.1 mg/L, APD and CT-1 restitutions were steep and flat, respectively. APD restitution became flattened when D600 increased to 0.5 mg/L, converting fast VF to VT. Further increasing D600 to 2.5 or 5.0 mg/L steepened CT-1 restitution and widened the range of S1 pacing cycle lengths over which CT-1 decreased, converting VT to slow VF.
Conclusions— Two types of VF exist in isolated rabbit hearts. Fast (type I) VF is associated with a steep APD restitution, a flat CT-1 restitution, and wandering wavelets. Slow (type II) VF is associated with a flat APD restitution, a steep CT-1 restitution, and spatiotemporal periodicity. Both excitability and APD restitution are important in VF maintenance.
Key Words: arrhythmia • fibrillation • mapping • ventricles
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