Circulation, Vol 55, 686-702, Copyright © 1977 by American Heart Association
N El-Sherif, BJ Scherlag, R Lazzara and RR Hope
Dogs 3-7 days following ligation of the anterior descending coronary artery
representing a remarkably stable model for re-entrant ventricular
arrhythmias (RVA) and allowed detailed electrophysiologic studies of the
re-entrant mechanism. In these dogs, we could regularly illustrate the
presence of continuous electrical activity originating from the infarction
zone (IZ) and bridging the diastolic interval between the initiating and
re-entrant beats as well as between consecutive re-entrant beats.
Conduction in the IZ was highly complex, with multiple potentially
re-entrant pathways, functionally dissociated areas, and areas of localized
ventricular fibrillation. Conduction disorders in ischemic myocardium were
consistently tachycardia- dependent with the spontaneous onset of RVA
specifically associated with a Wenckebach-like conduction pattern in a
potentially re-entrant pathway. Both manifest and concealed re-entry, as
well as re-entrant beats with regular extrasystolic grouping, constant or
variable coupling, uniform multiform and bidirectional QRS configurations,
were related to characteristic conduction patterns in the IZ. In summary,
the study provides the first direct in vivo evidence of ventricular re-
entry and demonstrates propensity for RVA and sudden death in the late
myocardial infarction period.
ARTICLES
Re-entrant ventricular arrhythmias in the late myocardial infarction period. 1. Conduction characteristics in the infarction zone
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