From the Division of Cardiology, Departments of Medicine (Y.Y.K., W.F.,
D.H., J.J.L., H.S.K., P.-S.C.) and Pathology (M.C.F.), Cedars-Sinai Medical
Center and University of California, Los Angeles, School of Medicine.
Correspondence to Dr Peng-Sheng Chen, Division of Cardiology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Room 5342, Los Angeles, CA 90048. E-mail chenp{at}csmc.edu
Background—There is increasing
evidence that both functional reentrant wave fronts and multiple
wavelets are present during ventricular fibrillation
(VF). However, the effects of procainamide on the
characteristics of activation waves during VF are poorly
understood.
Methods and Results—Seven dogs were studied; six underwent
subendocardial chemical ablation procedures. A plaque with 317 to 480
bipolar electrodes was sutured to the right ventricular
free wall, and the patterns of activation were registered with a
computerized mapping system. VF was electrically induced, and the
patterns of activation were registered at baseline and during
procainamide infusion (serum concentration, 9.3±1.9 µg/mL).
Among the six dogs that had their subendocardium ablated, reentrant
wave fronts were present in 6 of the 108 runs of VF at baseline and
in 6 of the 100 runs of VF during procainamide infusion. By
analyzing the wave fronts, we found that the cycle length, refractory
period, conduction velocity, and wavelength at baseline were 101±9 ms,
54±5 ms, 0.93±0.21 mm/ms, and 51±16 mm, respectively, and
during procainamide infusion, values became 125±11 ms
(P<.001), 119±7 ms (P<.001),
0.42±0.02 mm/ms (P<.001), and 50±4 mm
(P=.8), respectively. The vast majority of the
activation waves do not form organized reentry. These activation waves
broke up more frequently at baseline than during procainamide
administration. The number of activation waves was 7.25±1.39
s-1 · cm-2 at baseline and 4.45±1.80
s-1 · cm-2 during procainamide
administration (P<.001). The dog without subendocardial
ablation had similar results.
Conclusions—Procainamide decreases the number of wavelets
during VF by preventing spontaneous wave breaks. This
represents a novel mechanism of antiarrhythmic drug action.
© 1998 American Heart Association, Inc.
Basic Science Reports
Effects of Procainamide on Wave-Front Dynamics During Ventricular Fibrillation in Open-Chest Dogs
Key Words: procainamide • fibrillation • waves • conduction
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