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(Circulation. 2004;110:2110-2118.)
© 2004 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Mother Rotors and the Mechanisms of D600-Induced Type 2 Ventricular Fibrillation

Tsu-Juey Wu, MD, PhD; Shien-Fong Lin, PhD; Ali Baher, BS; Zhilin Qu, PhD; Alan Garfinkel, PhD; James N. Weiss, MD; Chih-Tai Ting, MD, PhD; Peng-Sheng Chen, MD

From the Cardiovascular Center (T.-J.W., C.-T.T.), Taichung Veterans General Hospital and Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan; and the Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center (S.-F.L., P.-S.C.) and Cardiovascular Research Laboratory (A.B., Z.Q., A.G., J.N.W.), David Geffen School of Medicine, UCLA, Los Angeles, Calif.

Correspondence to Tsu-Juey Wu, MD, PhD, Cardiovascular Center, Taichung Veterans General Hospital, 160, Section 3, Chung-Kang Road, Taichung, Taiwan. E-mail tjwu{at}vghtc.vghtc.gov.tw

Received March 21, 2004; revision received May 12, 2004; accepted May 19, 2004.

Background— Two types of ventricular fibrillation (VF) have been demonstrated in isolated rabbit hearts during D600 infusion. Type 1 VF is characterized by the presence of multiple, wandering wavelets, whereas type 2 VF shows local spatiotemporal periodicity. We hypothesized that a single mother rotor underlies type 2 VF.

Methods and Results— One (protocol I) or 2 (protocol II) cameras were used to map the epicardial ventricular activations in Langendorff-perfused rabbit hearts. Multiple episodes of type 2 VF were induced in 22 hearts by high-concentration (2.5 mg/L) D600 (protocol I). During type 2 VF, a single spiral wave (n=19) and/or an epicardial breakthrough pattern (n=11) was present in 14 hearts. These spiral waves either slowly drifted or intermittently anchored on the papillary muscle (PM) of the left ventricle. Dominant-frequency (DF) analyses showed that the highest local DF was near the PM (12.5±1.1 Hz). There was an excellent correlation between the highest local DF of these spiral waves and breakthroughs (11.8±1.7 Hz) and the DF of simultaneously obtained global pseudo-ECG (11.2±1.8 Hz, r=0.97, P<0.0001) during type 2 VF. We also successfully reproduced the major features of type 2 VF by using the Luo-Rudy action-potential model in a simulated, 3-dimensional tissue slab, under conditions of reduced excitability and flat action-potential duration restitution.

Conclusions— Either a stationary or a slowly drifting mother rotor can result in type 2 VF. Colocalization of the stationary mother rotors with the PM suggests the importance of underlying anatomic structures in mother rotor formation.

Key Words: arrhythmia • fibrillation • mapping • ventricles

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