Circulation, Vol 68, 518-533, Copyright © 1983 by American Heart Association
JJ Fenoglio Jr, TD Pham, AH Harken, LN Horowitz, ME Josephson and AL Wit
Surgical resection of the endocardium and subendocardium often abolishes
chronic recurrent sustained ventricular tachycardia in patients with healed
myocardial infarcts or ventricular aneurysms, presumably by interrupting
the reentrant pathway. To define the morphologic characteristics of cells
in the reentrant pathway, we studied the histology and ultrastructure of
the endocardial resections of 23 patients who underwent this procedure.
Bundles of apparently viable myocardial fibers embedded in dense fibrous
tissue were identified throughout the endocardial resections from all
patients. These bundles of cells were separated from one another by fibrous
tissue but extended uninterrupted to the margins of the surgical resection.
In 14 patients Purkinje fibers were identified beneath the thickened
endocardium whereas the remaining bundles were composed of ventricular
muscle. The Purkinje fibers appeared to have normal ultrastructure and
ventricular cells with both normal and abnormal ultrastructures were
present. The abnormal muscle cells were characterized by loss of
contractile elements, aggregates of dilated sarcoplasmic reticulum, and
osmiophilic dense bodies. The sarcolemma was intact and the nuclear
chromatin was evenly dispersed suggesting that these cells were still
viable. The abnormal structure and arrangement of the surviving cardiac
fibers in the endocardium may cause the abnormal electrophysiologic
function that results in ventricular tachycardia.
ARTICLES
Recurrent sustained ventricular tachycardia: structure and ultrastructure of subendocardial regions in which tachycardia originates
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