Circulation, Vol 86, 1872-1887, Copyright © 1992 by American Heart Association
SM Pogwizd, RH Hoyt, JE Saffitz, PB Corr, JL Cox and ME Cain
BACKGROUND. To determine the mechanisms of ventricular tachycardia (VT) in
humans, three-dimensional intraoperative mapping of up to 156 intramural
sites was performed in 13 patients with healed myocardial infarction and
refractory VT. METHODS AND RESULTS. Mapping was of sufficient density to
define the mechanism of 10 VTs in eight patients. In five of 10 cases,
sustained VT was initiated in the subendocardium or epicardium by
intramural reentry with marked conduction delay as well as functional and
anatomic block most prominent in the subendocardium and midmyocardium. The
initiating beats of reentrant VT induced by programmed electrical
stimulation arose in the endocardium or midmyocardium by progressive
slowing of conduction leading to unidirectional block. Multiple
simultaneous reentrant circuits can be present. In contrast, five of the 10
sustained VTs were initiated by a focal mechanism as defined by the absence
of electrical activity between the termination of one beat and the
initiation of the next despite the presence of multiple intervening
intramural electrode recording sites. Comparisons of the mapping data with
results of histopathological analysis of tissue demonstrated that the
location of infarction as well as that of adjacent fibrotic muscle
determined sites of both fixed and functional conduction block during
macroreentrant VT and that slowing of conduction occurred in a direction
transverse rather than longitudinal to fiber orientation. CONCLUSIONS. Both
intramural reentry and a focal mechanism underlie sustained VT in patients
with healed myocardial infarction.
ARTICLES
Reentrant and focal mechanisms underlying ventricular tachycardia in the human heart
Cardiovascular Division, Washington University School of Medicine, St. Louis, MO 63110.
This article has been cited by other articles:
 |
|
 |
|
  J. J. Goldberger, M. E. Cain, S. H. Hohnloser, A. H. Kadish, B. P. Knight, M. S. Lauer, B. J. Maron, R. L. Page, R. S. Passman, D. Siscovick, et al. American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific Statement on Noninvasive Risk Stratification Techniques for Identifying Patients at Risk for Sudden Cardiac Death: A Scientific Statement From the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention Circulation, September 30, 2008; 118(14): 1497 - 1518. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Kay, L. Swift, B. Martell, A. Arutunyan, and N. Sarvazyan Locations of ectopic beats coincide with spatial gradients of NADH in a regional model of low-flow reperfusion Am J Physiol Heart Circ Physiol, May 1, 2008; 294(5): H2400 - H2405. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Antoons, P. G. A. Volders, T. Stankovicova, V. Bito, M. Stengl, M. A. Vos, and K. R. Sipido Window Ca2+ current and its modulation by Ca2+ release in hypertrophied cardiac myocytes from dogs with chronic atrioventricular block J. Physiol., February 15, 2007; 579(1): 147 - 160. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Q. Yuan, G.-C. Fan, M. Dong, B. Altschafl, A. Diwan, X. Ren, H. H. Hahn, W. Zhao, J. R. Waggoner, L. R. Jones, et al. Sarcoplasmic Reticulum Calcium Overloading in Junctin Deficiency Enhances Cardiac Contractility but Increases Ventricular Automaticity Circulation, January 23, 2007; 115(3): 300 - 309. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Bogun, E. Good, S. Reich, D. Elmouchi, P. Igic, K. Lemola, D. Tschopp, K. Jongnarangsin, H. Oral, A. Chugh, et al. Isolated Potentials During Sinus Rhythm and Pace-Mapping Within Scars as Guides for Ablation of Post-Infarction Ventricular Tachycardia J. Am. Coll. Cardiol., May 16, 2006; 47(10): 2013 - 2019. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. E. Lehnart, C. Terrenoire, S. Reiken, X. H. T. Wehrens, L.-S. Song, E. J. Tillman, S. Mancarella, J. Coromilas, W. J. Lederer, R. S. Kass, et al. Stabilization of cardiac ryanodine receptor prevents intracellular calcium leak and arrhythmias PNAS, May 16, 2006; 103(20): 7906 - 7910. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
X. Zhang, I. Ramachandra, Z. Liu, B. Muneer, S. M. Pogwizd, and B. He Noninvasive three-dimensional electrocardiographic imaging of ventricular activation sequence Am J Physiol Heart Circ Physiol, December 1, 2005; 289(6): H2724 - H2732. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. R. Abraham, C. A. Henrikson, L. Tung, M. G. Chang, M. Aon, T. Xue, R. A. Li, B. O' Rourke, and E. Marban Antiarrhythmic Engineering of Skeletal Myoblasts for Cardiac Transplantation Circ. Res., July 22, 2005; 97(2): 159 - 167. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P.-S. Chen and J. N. Weiss Runaway Pacemakers in Ventricular Fibrillation Circulation, July 12, 2005; 112(2): 148 - 150. [Full Text] [PDF]
|
|
|
|
|
|
D. Xing and J. B. Martins Triggered activity due to delayed afterdepolarizations in sites of focal origin of ischemic ventricular tachycardia Am J Physiol Heart Circ Physiol, November 1, 2004; 287(5): H2078 - H2084. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. E. Diaz, S. C. O'Neill, and D. A. Eisner Sarcoplasmic Reticulum Calcium Content Fluctuation Is the Key to Cardiac Alternans Circ. Res., March 19, 2004; 94(5): 650 - 656. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Ouyang, M. Antz, F. T. Deger, D. Bansch, A. Schaumann, S. Ernst, and K.-H. Kuck An Underrecognized Subepicardial Reentrant Ventricular Tachycardia Attributable to Left Ventricular Aneurysm in Patients With Normal Coronary Arteriograms Circulation, June 3, 2003; 107(21): 2702 - 2709. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. St John Sutton, D. Lee, J. L. Rouleau, S. Goldman, T. Plappert, E. Braunwald, and M. A. Pfeffer Left Ventricular Remodeling and Ventricular Arrhythmias After Myocardial Infarction Circulation, May 27, 2003; 107(20): 2577 - 2582. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M Scoote, P A Poole-Wilson, and A J Williams The therapeutic potential of new insights into myocardial excitation-contraction coupling Heart, April 1, 2003; 89(4): 371 - 376. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Soejima, W. G. Stevenson, W. H. Maisel, J. L. Sapp, and L. M. Epstein Electrically Unexcitable Scar Mapping Based on Pacing Threshold for Identification of the Reentry Circuit Isthmus: Feasibility for Guiding Ventricular Tachycardia Ablation Circulation, September 24, 2002; 106(13): 1678 - 1683. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Arutunyan, L. M. Swift, and N. Sarvazyan Initiation and propagation of ectopic waves: insights from an in vitro model of ischemia-reperfusion injury Am J Physiol Heart Circ Physiol, August 1, 2002; 283(2): H741 - H749. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C.B. Brunckhorst, W.G. Stevenson, W.M. Jackman, K.-H. Kuck, K. Soejima, H. Nakagawa, R. Cappato, and S.A. Ben-Haim Ventricular mapping during atrial and ventricular pacing. Relationship of multipotential electrograms to ventricular tachycardia reentry circuits after myocardial infarction Eur. Heart J., July 2, 2002; 23(14): 1131 - 1138. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Kottkamp and G. Hindricks Catheter ablation of untolerated ventricular tachycardia--a new front line Eur. Heart J., May 1, 2002; 23(9): 697 - 699. [Full Text] [PDF]
|
|
|
|
|
|
S. Adachi-Akahane and Y. Kurachi New Era for Translational Research in Cardiac Arrhythmias Circ. Res., June 8, 2001; 88(11): 1095 - 1096. [Full Text] [PDF]
|
|
|
|
|
|
A. Arutunyan, D. R. Webster, L. M. Swift, and N. Sarvazyan Localized injury in cardiomyocyte network: a new experimental model of ischemia-reperfusion arrhythmias Am J Physiol Heart Circ Physiol, April 1, 2001; 280(4): H1905 - H1915. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Huang, J. M. Rogers, C. R. Killingsworth, G. P. Walcott, B. H. KenKnight, W. M. Smith, and R. E. Ideker Improvement of Defibrillation Efficacy and Quantification of Activation Patterns During Ventricular Fibrillation in a Canine Heart Failure Model Circulation, March 13, 2001; 103(10): 1473 - 1478. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Nitta, M. Mitsuno, C. K. Rokkas, R. Lee, R. B. Schuessler, and J. P. Boineau Cryoablation of ventricular tachycardia guided by return cycle mapping after entrainment J. Thorac. Cardiovasc. Surg., February 1, 2001; 121(2): 0249 - 258. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Pastore and D. S. Rosenbaum Role of Structural Barriers in the Mechanism of Alternans-Induced Reentry Circ. Res., December 8, 2000; 87(12): 1157 - 1163. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. A. Strickberger, B. P. Knight, G. F. Michaud, F. Pelosi, and F. Morady Mapping and ablation of ventricular tachycardia guided by virtual electrograms using a noncontact, computerized mapping system J. Am. Coll. Cardiol., February 1, 2000; 35(2): 414 - 421. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Becker, B. Merkely, A. Bauer, L. Geller, L. Fazekas, K. D. Freigang, F. Voss, J. C. Senges, W. Kuebler, and W. Schoels Ventricular arrhythmias induced by endothelin-1 or by acute ischemia: a comparative analysis using three-dimensional mapping Cardiovasc Res, January 14, 2000; 45(2): 310 - 320. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Pogwizd, J. P. McKenzie, and M. E. Cain Mechanisms Underlying Spontaneous and Induced Ventricular Arrhythmias in Patients With Idiopathic Dilated Cardiomyopathy Circulation, December 1, 1998; 98(22): 2404 - 2414. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. A Woodcock, S. J Matkovich, and O. Binah Ins(1,4,5)P3 and cardiac dysfunction Cardiovasc Res, November 1, 1998; 40(2): 251 - 256. [Full Text] [PDF]
|
|
|
|
|
|
T.-J. Wu, J. J. C. Ong, C. Hwang, J. J. Lee, M. C. Fishbein, L. Czer, A. Trento, C. Blanche, R. M. Kass, W. J. Mandel, et al. Characteristics of wave fronts during ventricular fibrillation in human hearts with dilated cardiomyopathy: role of increased fibrosis in the generation of reentry J. Am. Coll. Cardiol., July 1, 1998; 32(1): 187 - 196. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Zabel, T. Klingenheben, M. R. Franz, and S. H. Hohnloser Assessment of QT Dispersion for Prediction of Mortality or Arrhythmic Events After Myocardial Infarction : Results of a Prospective, Long-term Follow-up Study Circulation, June 30, 1998; 97(25): 2543 - 2550. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Priebe and D. J. Beuckelmann Simulation Study of Cellular Electric Properties in Heart Failure Circ. Res., June 15, 1998; 82(11): 1206 - 1223. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. S. Oster, B. Taccardi, R. L. Lux, P. R. Ershler, and Y. Rudy Electrocardiographic Imaging : Noninvasive Characterization of Intramural Myocardial Activation From Inverse-Reconstructed Epicardial Potentials and Electrograms Circulation, April 21, 1998; 97(15): 1496 - 1507. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Nitta, R. B. Schuessler, M. Mitsuno, C. K. Rokkas, F. Isobe, C. S. Cronin, J. L. Cox, and J. P. Boineau Return Cycle Mapping After Entrainment of Ventricular Tachycardia Circulation, March 31, 1998; 97(12): 1164 - 1175. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. K. Chung, S. M. Pogwizd, D. P. Miller, and M. E. Cain Three-dimensional Mapping of the Initiation of Nonsustained Ventricular Tachycardia in the Human Heart Circulation, June 3, 1997; 95(11): 2517 - 2527. [Abstract] [Full Text]
|
|
|
|
|
|
S. M. Pogwizd, M. K. Chung, and M. E. Cain Termination of Ventricular Tachycardia in the Human Heart: Insights From Three-dimensional Mapping of Nonsustained and Sustained Ventricular Tachycardias Circulation, June 3, 1997; 95(11): 2528 - 2540. [Abstract] [Full Text]
|
|
|
|
|
|
H. Kottkamp, G. Hindricks, E. Horst, T. Baal, C. Fechtrup, G. Breithardt, and M. Borggrefe Subendocardial and Intramural Temperature Response During Radiofrequency Catheter Ablation in Chronic Myocardial Infarction and Normal Myocardium Circulation, April 15, 1997; 95(8): 2155 - 2161. [Abstract] [Full Text]
|
|
|
|
|
|
P. Lander, P. Gomis, R. Goyal, E. J. Berbari, P. Caminal, R. Lazzara, and J. S. Steinberg Analysis of Abnormal Intra-QRS Potentials : Improved Predictive Value for Arrhythmic Events With the Signal-Averaged Electrocardiogram Circulation, March 18, 1997; 95(6): 1386 - 1393. [Abstract] [Full Text]
|
|
|
|
|
|
Y. Kawamura, P. L. Page, R. Cardinal, P. Savard, and R. Nadeau MAPPING OF SEPTAL VENTRICULAR TACHYCARDIA: CLINICAL AND EXPERIMENTAL CORRELATIONS J. Thorac. Cardiovasc. Surg., October 1, 1996; 112(4): 914 - 925. [Abstract] [Full Text]
|
|
|
|
|
|
D. J. Wilber, D. E. Kopp, D. N. Glascock DO, C. A. Kinder, and J. G. Kall Catheter Ablation of the Mitral Isthmus for Ventricular Tachycardia Associated With Inferior Infarction Circulation, December 15, 1995; 92(12): 3481 - 3489. [Abstract] [Full Text]
|
|
|
|
|
|
A. A. Grace and K. R. Chien Congenital Long QT Syndromes : Toward Molecular Dissection of Arrhythmia Substrates Circulation, November 15, 1995; 92(10): 2786 - 2789. [Full Text]
|
|
|
|
|
|
H. Kottkamp, G. Hindricks, X. Chen, J. Brunn, S. Willems, W. Haverkamp, M. Block, G. Breithardt, and M. Borggrefe Radiofrequency Catheter Ablation of Sustained Ventricular Tachycardia in Idiopathic Dilated Cardiomyopathy Circulation, September 1, 1995; 92(5): 1159 - 1168. [Abstract] [Full Text]
|
|
|
|
|
|
S. M. Pogwizd Nonreentrant Mechanisms Underlying Spontaneous Ventricular Arrhythmias in a Model of Nonischemic Heart Failure in Rabbits Circulation, August 15, 1995; 92(4): 1034 - 1048. [Abstract] [Full Text]
|
|
|
|
|
|
D. S. Khoury, B. Taccardi, R. L. Lux, P. R. Ershler, and Y. Rudy Reconstruction of Endocardial Potentials and Activation Sequences From Intracavitary Probe Measurements : Localization of Pacing Sites and Effects of Myocardial Structure Circulation, February 1, 1995; 91(3): 845 - 863. [Abstract] [Full Text]
|
|
|
|
|
|
S. M. Pogwizd, K. Schlotthauer, L. Li, W. Yuan, and D. M. Bers Arrhythmogenesis and Contractile Dysfunction in Heart Failure : Roles of Sodium-Calcium Exchange, Inward Rectifier Potassium Current, and Residual {beta}-Adrenergic Responsiveness Circ. Res., June 8, 2001; 88(11): 1159 - 1167. [Abstract] [Full Text] [PDF]
|
|