Circulation, Vol 67, 1356-1367, Copyright © 1983 by American Heart Association
CS Kuo, K Munakata, CP Reddy and B Surawicz
The arrhythmogenic role of increased dispersion of repolarization
(dispersion) was studied in 23 open-chest dogs using six simultaneously
recorded monophasic action potentials (MAPs) from the ventricular surface
and programmed ventricular premature stimulation (VPS). Increased
dispersion was induced by generalized hypothermia (29 degrees C) and
regional warm blood (38-43 degrees C) perfusion through a coronary artery
branch. Hypothermia and regional warm blood perfusion increased maximum
dispersion from 13 +/- 10 to 111 +/- 16 msec (p less than 0.001),
predominantly because of the increased MAP duration difference (10 +/- 15
vs 97 +/- 16 msec, p less than 0.001). The maximal difference between
activation times was not significantly changed, but the QRS duration
increased from 47 +/- 6 to 52 +/- 7 msec (p less than 0.01). Ventricular
arrhythmia did not occur spontaneously but was induced by a single VPS in
all 23 dogs during hypothermia and regional warm blood perfusion when
dispersion reached a critical magnitude. The critical magnitude of
dispersion required to induce ventricular arrhythmia was documented in 16
dogs by stepwise increments or decrements of dispersion. In four dogs, an
increase in atrial pacing rate of 24 beats/min prevented induction of
ventricular arrhythmia by decreasing dispersion from a critical magnitude
of 103 +/- 5 msec to a nonarrhythmogenic value of 86 +/- 9 msec (p less
than 0.05). In six dogs, we compared the stimulation site-dependent effects
of VPS applied in the region with short and long MAPs. In all dogs,
ventricular arrhythmia was inducible only by VPS from the region with a
short MAP. Premature impulses from this region propagated more slowly than
those from the region with a long MAP. Our results show that the large
dispersion of repolarization facilitates the development of a conduction
delay necessary to induce sustained arrhythmia by an early premature
stimulus applied at the site with a short MAP.
ARTICLES
Characteristics and possible mechanism of ventricular arrhythmia dependent on the dispersion of action potential durations
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L. De Ambroggi, E. Aime, C. Ceriotti, M. Rovida, and S. Negroni Mapping of Ventricular Repolarization Potentials in Patients With Arrhythmogenic Right Ventricular Dysplasia : Principal Component Analysis of the ST-T Waves Circulation, December 16, 1997; 96(12): 4314 - 4318. [Abstract] [Full Text]
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L. Gepstein, G. Hayam, and S. A. Ben-Haim Activation-Repolarization Coupling in the Normal Swine Endocardium Circulation, December 2, 1997; 96(11): 4036 - 4043. [Abstract] [Full Text]
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S. G. Priori, D. W. Mortara, C. Napolitano, L. Diehl, V. Paganini, F. Cantu, G. Cantu, and P. J. Schwartz Evaluation of the Spatial Aspects of T-Wave Complexity in the Long-QT Syndrome Circulation, November 4, 1997; 96(9): 3006 - 3012. [Abstract] [Full Text]
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M Zaidi, A Robert, R Fesler, C Derwael, and C Brohet Dispersion of ventricular repolarisation: a marker of ventricular arrhythmias in patients with previous myocardial infarction Heart, October 1, 1997; 78(4): 371 - 375. [Abstract] [Full Text] [PDF]
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R. D. Berger, E. K. Kasper, K. L. Baughman, E. Marban, H. Calkins, and G. F. Tomaselli Beat-to-Beat QT Interval Variability : Novel Evidence for Repolarization Lability in Ischemic and Nonischemic Dilated Cardiomyopathy Circulation, September 2, 1997; 96(5): 1557 - 1565. [Abstract] [Full Text]
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G. Stark, I. Schwarzl, U. Heiden, U. Stark, and H. A Tritthart Magnesium abolishes inadequate kinetics of frequency adaptation of the Q-aT interval in the presence of sotalol Cardiovasc Res, July 1, 1997; 35(1): 43 - 51. [Abstract] [Full Text] [PDF]
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S.C. Verduyn, M.A. Vos, J. van der Zande, F.F. van der Hulst, and H.J. Wellens Role of interventricular dispersion of repolarization in acquired torsade-de-pointes arrhythmias: reversal by magnesium Cardiovasc Res, June 1, 1997; 34(3): 453 - 463. [Abstract] [Full Text] [PDF]
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R. Coronel, T. Opthof, P. Taggart, J. Tytgat, and M. Veldkamp Differential electrophysiology of repolarisation from clone to clinic Cardiovasc Res, March 1, 1997; 33(3): 503 - 517. [PDF]
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M. A. Wood, R. A. Mangano, R. M. Schieken, C. M. Baumgarten, P. M. Simpson, and K. A. Ellenbogen Modulation of Atrial Repolarization by Site of Pacing in the Isolated Rabbit Heart Circulation, September 15, 1996; 94(6): 1465 - 1470. [Abstract] [Full Text]
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K. R. Laurita, S. D. Girouard, and D. S. Rosenbaum Modulation of Ventricular Repolarization by a Premature Stimulus: Role of Epicardial Dispersion of Repolarization Kinetics Demonstrated by Optical Mapping of the Intact Guinea Pig Heart Circ. Res., September 1, 1996; 79(3): 493 - 503. [Abstract] [Full Text]
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S.M. Horner, D.J. Dick, C.F. Murphy, and M.J. Lab Cycle Length Dependence of the Electrophysiological Effects of Increased Load on the Myocardium Circulation, September 1, 1996; 94(5): 1131 - 1136. [Abstract] [Full Text]
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 J. S. Perkiomaki, M. J. Ikaheimo, S. M. Pikkujamsa, A. Rantala, M. Lilja, Y. A. Kesaniemi, and H. V. Huikuri Dispersion of the QT Interval and Autonomic Modulation of Heart Rate in Hypertensive Men With and Without Left Ventricular Hypertrophy Hypertension, July 1, 1996; 28(1): 16 - 21. [Abstract] [Full Text]
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A. van de Loo, T. Klingenheben, and S. H. Hohnloser Amiodarone Therapy After Previous Sotalol-induced Torsade de Pointes: Analysis of QT Dispersion to Predict Proarrhythmia Journal of Cardiovascular Pharmacology and Therapeutics, January 1, 1996; 1(1): 75 - 78. [Abstract] [PDF]
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A. Kanai and G. Salama Optical Mapping Reveals That Repolarization Spreads Anisotropically and Is Guided by Fiber Orientation in Guinea Pig Hearts Circ. Res., October 1, 1995; 77(4): 784 - 802. [Abstract] [Full Text]
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O. H. Tovar and J. L. Jones Biphasic Defibrillation Waveforms Reduce Shock-Induced Response Duration Dispersion Between Low and High Shock Intensities Circ. Res., August 1, 1995; 77(2): 430 - 438. [Abstract] [Full Text]
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R. Coronel, F. J. G. Wilms-Schopman, L. R. C. Dekker, and M. J. Janse Heterogeneities in [K+]o and TQ Potential and the Inducibility of Ventricular Fibrillation During Acute Regional Ischemia in the Isolated Perfused Porcine Heart Circulation, July 1, 1995; 92(1): 120 - 129. [Abstract] [Full Text]
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A. R. R. Misier, T. Opthof, N. M. van Hemel, J. T. Vermeulen, J. M.T. de Bakker, J. J.A.M. Defauw, F. J.L. van Capelle, and M. J. Janse Dispersion of `Refractoriness' in Noninfarcted Myocardium of Patients With Ventricular Tachycardia or Ventricular Fibrillation After Myocardial Infarction Circulation, May 15, 1995; 91(10): 2566 - 2572. [Abstract] [Full Text]
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P. Smetana, V. N. Batchvarov, K. Hnatkova, A. J. Camm, and M. Malik Sex differences in repolarization homogeneity and its circadian pattern Am J Physiol Heart Circ Physiol, May 1, 2002; 282(5): H1889 - H1897. [Abstract] [Full Text] [PDF]
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