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(Circulation. 1999;100:1450-1459.)
© 1999 American Heart Association, Inc.

Basic Science Reports

Role of Papillary Muscle in the Generation and Maintenance of Reentry During Ventricular Tachycardia and Fibrillation in Isolated Swine Right Ventricle

Young-Hoon Kim, MD; Fagen Xie, PhD; Masaaki Yashima, MD; Tsu-Juey Wu, MD; Miguel Valderrábano, MD; Moon-Hyoung Lee, MD; Toshihiko Ohara, MD; Olga Voroshilovsky, MS; Rahul N. Doshi, MD; Michael C. Fishbein, MD; Zhilin Qu, PhD; Alan Garfinkel, PhD; James N. Weiss, MD; Hrayr S. Karagueuzian, PhD; Peng-Sheng Chen, MD

From the Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center (Y.-H.K., M.Y., T.-J.W., M.V., M.-H.L., T.O., O.V., R.N.D., H.S.K., P.-S.C.), and the Division of Cardiology, Departments of Medicine, Physiology, and Physiological Science (F.X., Z.Q., A.G., J.N.W.) and Pathology (M.C.F.), UCLA School of Medicine, Los Angeles, Calif; and Korea University, Seoul, Korea (Y.-H.K.). Dr Kim is now at the Division of Cardiology, Department of Medicine, Korea University, Seoul, Korea.

Correspondence to Peng-Sheng Chen, MD, Room 5342, CSMC, 8700 Beverly Blvd, Los Angeles, CA 90048. E-mail chenp{at}csmc.edu

Background—The role of papillary muscle (PM) in the generation and maintenance of reentry is unclear.

Methods and Results—Computerized mapping (477 bipolar electrodes, 1.6-mm resolution) was performed in fibrillating right ventricles (RVs) of swine in vitro. During ventricular fibrillation (VF), reentrant wave fronts often transiently anchored to the PM. Tissue mass reduction was then performed in 10 RVs until VF converted to ventricular tachycardia (VT). In an additional 6 RVs, procainamide infusion converted VF to VT. Maps showed that 77% (34 of 44) of all VT episodes were associated with a single reentrant wave front anchored to the PM. Purkinje fiber potentials preceded the local myocardial activation, and these potentials were recorded mostly around the PM. When PM was trimmed to the level of endocardium (n=4), sustained VT was no longer inducible. Transmembrane potential recordings (n=5) at the PM revealed full action potential during pacing, without evidence of ischemia. Computer simulation studies confirmed the role of PM as a spiral wave anchoring site that stabilized wave conduction.

Conclusions—We conclude that PM is important in the generation and maintenance of reentry during VT and VF.

Key Words: death, sudden • electrophysiology • waves • procainamide • antiarrhythmia agents

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