Circulation, Vol 89, 852-862, Copyright © 1994 by American Heart Association
L Boersma, J Brugada, C Kirchhof and M Allessie
BACKGROUND: Premature stimulation is used to characterize the reentrant
circuit during ventricular tachycardia (VT) in patients. The goal of this
study was to compare the effects of premature stimulation on functional and
anatomic reentrant VT. METHODS AND RESULTS: In 18 Langendorff-perfused
rabbit hearts, thin layers of anisotropic left ventricular subepicardium
were created by a cryoprocedure. In 8 hearts, rapid pacing induced reentry
around a line of functional conduction block; in 10 hearts, reentry
occurred around a fixed epicardial obstacle created by a cryoprobe. The
cycle lengths (CL) of functional and anatomic VT were 110 +/- 10 and 167
+/- 17 milliseconds, respectively. During anatomic VT, the excitable gap
measured 43% of the CL and premature stimuli could always reset VT (44 +/-
12 milliseconds). During early premature beats, conduction of the
orthodromic wave was slightly depressed, but anatomic VT was never
terminated. Reset curves at different sites in the ventricle revealed three
different response types, both determined by and characterizing the spatial
and temporal relation between pacing and recording sites. Premature
stimulation during functional VT revealed a local excitable gap at the
pacing site measuring 27% of the cycle length of VT. However, in only 3 of
8 hearts, premature stimuli could reset functional VT by 8%. In 5 VTs,
advancement of the paced activation was fully compensated by prolongation
of the return cycle, and VT was not reset. Due to slow conduction both
toward and inside the circuit, the paced orthodromic wave lost its
prematurity already within a distance of 6 to 10 mm from the pacing site.
CONCLUSIONS: Both during anatomic and functional reentry, an excitable gap
is present in the reentrant circuit. Three different response curves reveal
the localization of the pacing and recording sites in the circuit. Anatomic
VT can always be reset by premature stimuli, whereas in 5 of 8 hearts,
functional VT could not be reset. In the other 3 hearts, VT could only be
reset for less than 7% to 11% of the VT interval. Therefore, it seems very
unlikely that clinical VT based on functional reentry can be reset.
ARTICLES
Mapping of reset of anatomic and functional reentry in anisotropic rabbit ventricular myocardium
Department of Physiology, University of Limburg, Maastricht, The Netherlands.
This article has been cited by other articles:
 |
|
 |
|
  W. Bian and L. Tung Structure-Related Initiation of Reentry by Rapid Pacing in Monolayers of Cardiac Cells Circ. Res., March 3, 2006; 98(4): e29 - e38. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. G. KLEBER and Y. RUDY Basic Mechanisms of Cardiac Impulse Propagation and Associated Arrhythmias Physiol Rev, April 1, 2004; 84(2): 431 - 488. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Iravanian, Y. Nabutovsky, C.-R. Kong, S. Saha, N. Bursac, and L. Tung Functional reentry in cultured monolayers of neonatal rat cardiac cells Am J Physiol Heart Circ Physiol, June 5, 2003; 285(1): H449 - H456. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Bursac, K.K. Parker, S. Iravanian, and L. Tung Cardiomyocyte Cultures With Controlled Macroscopic Anisotropy: A Model for Functional Electrophysiological Studies of Cardiac Muscle Circ. Res., December 13, 2002; 91 (12): e45 - e54. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Boersma, Z. Zetelaki, J. Brugada, and M. Allessie Polymorphic Reentrant Ventricular Tachycardia in the Isolated Rabbit Heart Studied by High-Density Mapping Circulation, June 25, 2002; 105(25): 3053 - 3061. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Hanna, J. Coromilas, M. E. Josephson, A. L. Wit, and N. S. Peters Mechanisms of Resetting Reentrant Circuits in Canine Ventricular Tachycardia Circulation, February 27, 2001; 103(8): 1148 - 1156. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. H. Samie, R. Mandapati, R. A. Gray, Y. Watanabe, C. Zuur, J. Beaumont, and J. Jalife A Mechanism of Transition From Ventricular Fibrillation to Tachycardia : Effect of Calcium Channel Blockade on the Dynamics of Rotating Waves Circ. Res., March 31, 2000; 86(6): 684 - 691. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Haberl and M. Allessie Differential Effects of a Segment of Slow Conduction on Reentrant Ventricular Tachycardia in the Rabbit Heart Circulation, February 23, 1999; 99(7): 949 - 962. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Robert, A. G. M. Aya, J. E. de la Coussaye, P. Peray, J.-M. Juan, J. Brugada, J.-M. Davy, and J.-J. Eledjam Dispersion-based reentry: mechanism of initiation of ventricular tachycardia in isolated rabbit hearts Am J Physiol Heart Circ Physiol, February 1, 1999; 276(2): H413 - H423. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. F. Kirchhof, C. L. Fabritz, and M. R. Franz Postrepolarization Refractoriness Versus Conduction Slowing Caused by Class I Antiarrhythmic Drugs : Antiarrhythmic and Proarrhythmic Effects Circulation, June 30, 1998; 97(25): 2567 - 2574. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. S. Peters, J. Coromilas, M. S. Hanna, M. E. Josephson, C. Costeas, and A. L. Wit Characteristics of the Temporal and Spatial Excitable Gap in Anisotropic Reentrant Circuits Causing Sustained Ventricular Tachycardia Circ. Res., February 9, 1998; 82(2): 279 - 293. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. F. Kwaku and S. M. Dillon Shock-Induced Depolarization of Refractory Myocardium Prevents Wave-Front Propagation in Defibrillation Circ. Res., November 1, 1996; 79(5): 957 - 973. [Abstract] [Full Text]
|
|
|
|
|
|
H. Fei, M. S. Hanna, and L. H. Frame Assessing the Excitable Gap in Reentry by Resetting: Implications for Tachycardia Termination by Premature Stimuli and Antiarrhythmic Drugs Circulation, November 1, 1996; 94(9): 2268 - 2277. [Abstract] [Full Text]
|
|
|
|
|
|
J. M. Davidenko, R. Salomonsz, A. M. Pertsov, W. T. Baxter, and J. Jalife Effects of Pacing on Stationary Reentrant Activity : Theoretical and Experimental Study Circ. Res., December 1, 1995; 77(6): 1166 - 1179. [Abstract] [Full Text]
|
|
|
|
|
|
F. H. Samie, O. Berenfeld, J. Anumonwo, S. F. Mironov, S. Udassi, J. Beaumont, S. Taffet, A. M. Pertsov, and J. Jalife Rectification of the Background Potassium Current: A Determinant of Rotor Dynamics in Ventricular Fibrillation Circ. Res., December 7, 2001; 89(12): 1216 - 1223. [Abstract] [Full Text] [PDF]
|
|