CLINICAL PERSPECTIVE

This Article Abstract Full Text (PDF) All Versions of this Article: 116/10/1113    most recent CIRCULATIONAHA.107.699264v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tabereaux, P. B. Articles by Ideker, R. E. Search for Related Content PubMed PubMed Citation Articles by Tabereaux, P. B. Articles by Ideker, R. E. Related Collections Electrophysiology Animal models of human disease Arrythmias-basic studies

(Circulation. 2007;116:1113-1119.)
© 2007 American Heart Association, Inc.

Arrhythmia/Electrophysiology

CLINICAL PERSPECTIVE

Of the hundreds of thousands of sudden cardiac deaths every year, many are caused by ventricular fibrillation (VF). For well over 50 years, it has been thought that VF is maintained by reentry within the working myocardium. Although the Purkinje fibers of the specialized conduction system have been shown to initiate VF in a small number of patients, their role in the maintenance of VF, if any, has not been known. This study mapped the activation sequences of the Purkinje fibers and of the working myocardium on the endocardium of the dog heart during VF that lasted for 10 minutes and found that the Purkinje fibers are active during this period. In addition to the working myocardium, which activates the Purkinje fibers in a retrograde fashion, the Purkinje fibers were observed to activate the working myocardium via an antegrade mechanism, which indicates that the Purkinje fibers are responsible at least in part for the maintenance of VF. In addition, activation appeared to arise focally on the endocardium in some cases, which raises the possibility that abnormal automaticity and/or triggered activity is present during VF. If confirmed, these findings suggest that therapy focused on the Purkinje fibers, on abnormal automaticity, and/or on triggered activity, in addition to therapy focused on reentry in the working myocardium, may cause VF to be easier to halt or to be more likely to stop spontaneously.

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This Article Abstract Full Text (PDF) All Versions of this Article: 116/10/1113    most recent CIRCULATIONAHA.107.699264v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tabereaux, P. B. Articles by Ideker, R. E. Search for Related Content PubMed PubMed Citation Articles by Tabereaux, P. B. Articles by Ideker, R. E. Related Collections Electrophysiology Animal models of human disease Arrythmias-basic studies