Circulation, Vol 68, 644-656, Copyright © 1983 by American Heart Association
N El-Sherif, R Mehra, WB Gough and RH Zeiler
Both sustained and nonsustained ventricular tachycardias were reproducibly
induced in dogs 3 to 5 days after ligation of the left anterior descending
coronary artery. Isochronal maps of ventricular activation were constructed
from close bipolar electrograms recorded from the entire epicardial surface
and selected intramural sites by a computerized multiplexing technique. The
electrophysiologic data were correlated with the anatomic characteristics
of the infarction. The induced tachycardias were due to reentrant
activation in the surviving epicardial layer overlying the infarction.
Cooling or cryoablation was applied to localized epicardial sites along the
reentrant circuit to reversibly or permanently interrupt reentrant
activation. The reentrant circuit could be consistently interrupted when
cooling or cryoablation was applied to the distal part of the common
reentrant wave front proximal to the site of earliest reactivation.
Localized cooling of the site of earliest reactivation usually failed to
interrupt reentry because the common reentrant wave front reactivated other
sites close to the original reactivation site. Before interruption of
reentry, cooling resulted in characteristic changes in conduction of the
reentrant wave front. The study (1) fulfills Mines' criteria that circus
movement reentry is the mechanism of the induced rhythms in this canine
experimental model and (2) identifies the critical site along the reentrant
circuit at which cryothermal ablation (or surgical interruption) of
reentrant activation could be successfully accomplished.
ARTICLES
Reentrant ventricular arrhythmias in the late myocardial infarction period. Interruption of reentrant circuits by cryothermal techniques
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