Circulation, Vol 84, 1296-1306, Copyright © 1991 by American Heart Association
J Brugada, L Boersma, CJ Kirchhof, VV Heynen and MA Allessie
BACKGROUND. The purpose of this study was to investigate the role of tissue
anisotropy and dispersion of refractoriness on initiation of reentrant
ventricular tachycardia (VT). METHODS AND RESULTS. A ring of perfused
uniform anisotropic ventricular epicardium in Langendorff- perfused rabbit
hearts was created by an endocardial freezing technique. High-resolution
mapping (248 channels) was used to analyze epicardial activation of the
left ventricle. One to three premature beats were induced at a total of 272
points in 17 experiments (16 different points around the ring in each
experiment). Reentrant VT could be initiated at 43 of the 272 points
tested. The cycle length of VT was stable and ranged from 128 to 198 msec
(mean, 161 +/- 19 msec). Correlation between conduction velocity and the
angle between the circulating activation wave and epicardial fiber
orientation showed that in segments of the ring where conduction was
perpendicular to the fiber axis, mean conduction velocity was 25 +/- 5
cm/sec compared with 60 +/- 7 cm/sec when conduction was parallel to the
fiber orientation. Analysis of the site of unidirectional conduction block
showed that in 41 of 43 cases, block occurred while the impulse was
propagating parallel to the fiber orientation. Measurement of the
refractory periods at either side of the line of unidirectional block
showed that only in 12 of 43 cases did block occur while the impulse was
propagating into an area with a longer (more than 10 msec) refractory
period. CONCLUSIONS. In uniform anisotropic ventricular myocardium,
reentrant VT is initiated because lowering the stimulating efficacy of the
depolarization wave by premature beats leads to preferential conduction
block parallel to the fiber orientation.
ARTICLES
Reentrant excitation around a fixed obstacle in uniform anisotropic ventricular myocardium
Department of Physiology, University of Limburg, Maastricht, The Netherlands.
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