Search

Introduction: We hypothesize that local modifications in electrophysiological properties, when confined to zones of limited extent, induce few changes in the global activation process during ventricular fibrillation (VF). To test this hypothesis, we produced local electrophysiological modifications by stretching a circumscribed zone of the left ventricular wall in an experimental model of VF. Methods and Results: In 23 Langendorff-perfused rabbit hearts frequency, time–frequency and time-domain techniques were used to analyze the VF recordings obtained with two epicardial multiple electrodes before, during, and after local stretching produced with a left intraventricular device. Acute local stretching accelerated VF in the stretched zone reversibly and to a variable degree, depending on the magnitude of stretch and the time elapsed from its application. In the half time (5 minutes) of the analyzed period, a longitudinal lengthening of 12.1 ± 4.5% (vertical axis) and 11.8 ± 6.2% (horizontal axis) in the stretched zone produced an increase in the dominant frequency (DFr) (15.2 ± 1.9 versus 18.8 ± 2.5 Hz, P < 0.0001), a decrease in mean VV interval (63 ± 8 versus 53 ± 6 msec, P < 0.001), and an increase in the complexity of the activation maps—with more areas of conduction block and more breakthrough patterns (23% versus 37%, P < 0.01), without significant changes in the percentages of complete reentry patterns (9% versus 9%, ns). Simultaneously, in the nonstretched zone, no variations were observed in the DFr (15.2 ± 2.1 versus 15.3 ± 2.5 Hz, ns), mean VV intervals (66 ± 8 versus 65 ± 8 msec, ns), or types and percentages of maps with breakthrough (25% versus 20%, ns) or reentry patterns (12% versus 8%, ns). No significant correlation was observed between the DFr in the two zones (R = 0.24, P = 0.40). Conclusion: Local stretching increases the electrophysiological heterogeneity of myocardium and accelerates and increases the complexity of VF in the stretched area, without significantly modifying the occurrences of the types of VF activation patterns in the nonstretched zone. [ABSTRACT FROM AUTHOR]

Background: The diagnostic significance of a tilt table test (TTT) in patients with a suspected arrhythmic etiology for syncope and negative electrophysiologic study (EPS) has not been previously assessed comparing the TTT results with the findings of prolonged monitoring using an implantable loop recorder (ILR). We sought to assess the diagnostic yielding of TTT in patients with suspected arrhythmic syncope and negative EPS. Methods and Results: In 81 patients with suspected arrhythmic etiology for syncope and negative EPS, TTT was performed and an ILR implanted regardless the results of TTT. TTT was positive in 38 patients. During follow-up, syncope or presyncope recurred in 32 patients (39.5%). No differences were found in recurrence rates in patients with positive and negative TTT (31.5% vs 46.5%, P = ns). According to rhythm registered during ILR activation, mechanisms of syncopal events were classified as: arrhythmic (atrioventricular [AV] block and ventricular tachycardia; n = 18), neurally mediated (sinus bradycardia and sinus pause; n = 9), and indeterminate (normal sinus rhythm; n = 5). There was no statistical association between the results of TTT and the mechanism of syncope. Conclusions: In patients with a suspected arrhythmic etiology for syncope and a negative EPS, TTT is of little value to predict the mechanism of syncope and the ILR implantation seems to be a useful and safe diagnostic strategy. [ABSTRACT FROM AUTHOR]

CHORRO, F.J., et al.: Dofetilide Effects on the Inhibition by Trains of Subthreshold Conditioning Stimuli. We investigated the electrophysiological actions of dofetilide upon the ventricular myocardium to determine whether the drug modifies the inhibitory effects of subthreshold stimuli trains upon ventricular refractoriness. In nine Langendorff perfused rabbit hearts, ventricular epicardial electrodes were used to determine the following parameters at baseline and during dofetilide perfusion (0.5 micromolar): effective (ERP) and functional (FRP) refractory periods, conduction velocity (CV), wavelength (WL), and ERP prolongation (inhibitory effect) induced by subthreshold stimuli trains (STr) at pulse frequencies of 100, 300, and 600 Hz. Dofetilide significantly prolongs ventricular refractoriness and WL: ERP increment (Dofetilide-baseline, 300 ms cycle length) = 33 ± 20 ms (24 ± 12%, P < 0.01); FRP increment = 37 ± 19 ms (23%± 10%, P < 0.01); WL increment = 4.1 ± 3.2 cm (27%± 20%, P < 0.01), without modifying CV. These effects are diminished upon increasing the stimulation frequency: ERP increment (Dofetilide-baseline, 150 ms cycle length) = 18 ± 10 ms (18%± 12%, P < 0.05); FRP increment = 15 ± 4 ms (14%± 5%, P < 0.01); WL increment = 1.9 ± 1.7 cm (18%± 10%, P < 0.01). The STr significantly prolong ERP, and the increments obtained at baseline and during dofetilide perfusion are similar. In both cases the inhibitory effect is slight for STr of 100 Hz (baseline = 5 ± 3 ms, dofetilide = 6 ± 5 ms, with nonsignificant (ns) differences between them) and highly manifest for STr of 300 Hz (baseline = 76 ± 33 ms, dofetilide = 87 ± 32 ms, ns) and 600 Hz (baseline = 109 ± 39 ms, dofetilide = 89 ± 34 ms, ns). Dofetilide prolongs ventricular refractoriness and WL, exerting a reverse-frequency dependent effect without modifying CV. The inhibitory effect of STr is greater when their pulse frequency is increased, and its magnitude is similar under the influence of dofetilide. During dofetilide perfusion the inhibitory effect of STr adds to the ERP prolongation induced by the drug. (PACE 2004; 27:327–332) [ABSTRACT FROM AUTHOR]

Mapping techniques are used to study the significance of the morphological patterns of the electrograms (EGMs) obtained during VF in an experimental model. In 24 isolated rabbit heart preparations recordings were made of activation during VF using a multiple electrode (121 unipolar electrodes) positioned on the lateral wall of the left ventricle. Three types of activation maps were selected: (A) with functional block of an activation front; (B) with epicardial breakthrough; and (C) with a single broad wavefront without block lines. The EGMs were classified as negative (Q), positive-negative with a predominance of the negative (rS) or positive wave (Rs), and positive (R). In 60 type A maps the morphology in the zone limiting the block line corresponded to an R wave in 55 (92%) cases and to Rs in 5 (8%) cases. In 67 type B maps, the EGM in the earliest activation zone most often showed Q wave morphology (48 [72%] cases), followed by rS (18 [27%] cases), and Rs morphology (1 [1%] case); in no case was R wave morphology seen. Finally, in 78 type C maps the morphology corresponded to a Q wave in 15 (19%) cases, rS in 38 (49%), Rs in 24 (31%), and R in a 1 (1%) case. The differences between the three types of maps were significant (P < 0.0001). Q wave EGM sensitivity for indicating the existence of an epicardial breakthrough pattern was 72%, with a specificity of 89%, and positive and negative predictive values of 76% and 87%, respectively. R wave EGM sensitivity for indicating the existence of conduction block was 92%, with a specificity of 99%, and positive and negative predictive values of 98% and 97%, respectively. R wave morphology is highly sensitive and specific for indicating conduction block. EGM recordings with initial positivity predominance are infrequent in the earliest activation zones of epicardial breakthrough during VF. The recording of the EGM with Q wave morphology indicates centrifugal activation from the explored zone. (PACE 2003; 26:1262–1269). [ABSTRACT FROM AUTHOR]