05025nas a2200385 4500008004100000022001400041245011300055210006900168260001200237300001100249490000700260520391000267653002204177653001204199653002704211653002504238653002404263653001004287653002804297653004004325653002704365653002904392653001404421653001604435653001404451653001404465653001204479653002404491100001304515700001904528700001704547700001404564700001404578856004704592 1997 eng d a0735-109700aOptical mapping of drug-induced polymorphic arrhythmias and torsade de pointes in the isolated rabbit heart.0 aOptical mapping of druginduced polymorphic arrhythmias and torsa c03/1997 a831-420 v293 a

OBJECTIVES: 

This study sought to 1) test the hypothesis that in the setting of bradycardia and drug-induced action potential prolongation, multiple foci of early afterdepolarizations (EADs) result in beat to beat changes in the origin and direction of the excitation wave front and are responsible for polymorphic arrhythmias; and 2) determine whether EADs may initiate nonstationary reentry, giving rise to the typical torsade de pointes (TDP) pattern.

BACKGROUND: 

In the past, it has been difficult to associate EADs or reentry with the undulating electrocardiographic (ECG) patterns of TDP.

METHODS: 

A voltage-sensitive dye was used for high resolution video imaging of electrical waves on the epicardial and endocardial surface of the Langendorff-perfused rabbit heart. ECG and monophasic action potentials from the right septal region were also recorded. Bradycardia was induced by ablation of the atrioventricular node.

RESULTS: 

Perfusion of low potassium chloride Tyrode solution plus quinidine led to prolongation of the action potential and the QT interval. Eventually, EADs and triggered activity ensued, giving rise to intermittent episodes of polymorphic arrhythmia. In one experiment, triggered activity was followed by a long episode of vortex-like reentry with an ECG pattern characteristic of TDP. However, in most experiments, focal activity of varying origins and propagation patterns was observed. Triggered responses also showed varying degrees of local block. Similar results were obtained with E-4031. Burst pacing both at control conditions and in the presence of quinidine consistently led to vortex-like reentry whose ECG pattern resembled TDP. However, the cycle length of the arrhythmia with quinidine was longer than that for control ([mean +/- SEM] 194 +/- 12 vs. 132 +/- 8 ms, p < 0.03).

CONCLUSIONS: 

Drug-induced polymorphic ventricular arrhythmias may result from beat to beat changes in wave propagation patterns initiated by EADs or EAD-induced nonstationary reentrant activity. In contrast, burst pacing-induced polymorphic tachycardia in the presence or absence of drugs is the result of nonstationary reentrant activity.

10aAction Potentials10aAnimals10aAnti-Arrhythmia Agents10aArrhythmias, Cardiac10aElectrocardiography10aHeart10aHeart Conduction System10aImage Processing, Computer-Assisted10aModels, Cardiovascular10aOrgan Culture Techniques10aPerfusion10aPiperidines10aPyridines10aQuinidine10aRabbits10aTorsades de Pointes1 aAsano, Y1 aDavidenko, J M1 aBaxter, Bill1 aGray, R A1 aJalife, J uhttp://www.ncbi.nlm.nih.gov/pubmed/909153103423nas a2200337 4500008004100000022001400041245009300055210006900148260001200217300001200229490000700241520247800248653001202726653002402738653002602762653001002788653001602798653002802814653001102842653002702853653002902880653001002909653002602919100001202945700001702957700001702974700001902991700001403010700001403024856004703038 1994 eng d a0009-733000aWave-front curvature as a cause of slow conduction and block in isolated cardiac muscle.0 aWavefront curvature as a cause of slow conduction and block in i c12/1994 a1014-280 v753 a

We have investigated the role of wave-front curvature on propagation by following the wave front that was diffracted through a narrow isthmus created in a two-dimensional ionic model (Luo-Rudy) of ventricular muscle and in a thin (0.5-mm) sheet of sheep ventricular epicardial muscle. The electrical activity in the experimental preparations was imaged by using a high-resolution video camera that monitored the changes in fluorescence of the potentiometric dye di-4-ANEPPS on the surface of the tissue. Isthmuses were created both parallel and perpendicular to the fiber orientation. In both numerical and biological experiments, when a planar wave front reached the isthmus, it was diffracted to an elliptical wave front whose pronounced curvature was very similar to that of a wave front initiated by point stimulation. In addition, the velocity of propagation was reduced in relation to that of the original planar wave. Furthermore, as shown by the numerical results, wave-front curvature changed as a function of the distance from the isthmus. Such changes in local curvature were accompanied by corresponding changes in velocity of propagation. In the model, the critical isthmus width was 200 microns for longitudinal propagation and 600 microns for transverse propagation of a single planar wave initiated proximal to the isthmus. In the experiments, propagation depended on the width of the isthmus for a fixed stimulation frequency. Propagation through an isthmus of fixed width was rate dependent both along and across fibers. Thus, the critical isthmus width for propagation was estimated in both directions for different frequencies of stimulation. In the longitudinal direction, for cycle lengths between 200 and 500 milliseconds, the critical width was < 1 mm; for 150 milliseconds, it was estimated to be between 1.3 and 2 mm; and for the maximum frequency of stimulation (117 +/- 15 milliseconds), it was > 2.5 mm. In the transverse direction, critical width was between 1.78 and 2.32 mm for a basic cycle length of 200 milliseconds. It increased to values between 2.46 and 3.53 mm for a basic cycle length of 150 milliseconds. The overall results demonstrate that the curvature of the wave front plays an important role in propagation in two-dimensional cardiac muscle and that changes in curvature may cause slow conduction or block.

10aAnimals10aComputer Simulation10aElectric Conductivity10aHeart10aHeart Block10aHeart Conduction System10aHumans10aModels, Cardiovascular10aMotion Pictures as Topic10aSheep10aStaining and Labeling1 aCabo, C1 aPertsov, A V1 aBaxter, Bill1 aDavidenko, J M1 aGray, R A1 aJalife, J uhttp://www.ncbi.nlm.nih.gov/pubmed/752510102348nas a2200313 4500008004100000022001400041245009000055210006900145260000900214300001100223490001300234520141700247653001201664653003101676653002101707653002801728653002401756653002501780653001601805653004101821653001601862653002501878100001901903700001701922700001701939700001701956700001401973856004701987 1992 eng d a0022-073600aSpatiotemporal irregularities of spiral wave activity in isolated ventricular muscle.0 aSpatiotemporal irregularities of spiral wave activity in isolate c1992 a113-220 v24 Suppl3 a

Voltage-sensitive dyes and high resolution optical mapping were used to analyze the characteristics of spiral waves of excitation in isolated ventricular myocardium. In addition, analytical techniques, which have been previously used in the study of the characteristics of spiral waves in chemical reactions, were applied to determine the voltage structure of the center of the rotating activity (ie, the core). During stable spiral wave activity local activation occurs in a periodic fashion (ie, 1:1 stimulus: response activation ratio) throughout the preparation, except at the core, which is a small elongated area where the activity is of low voltage and the activation ratio is 1:0. The voltage amplitude increases gradually from the center of the core to the periphery. In some cases, however, regular activation patterns at the periphery may coexist with irregular local activation patterns near the core. Such a spatiotemporal irregularity is attended by variations in the core size and shape and results from changes in the core position. The authors conclude that functionally determined reentrant activity in the heart may be the result of spiral waves of propagation and that local spatiotemporal irregularities in the activation pattern are the result of changes in the core position.

10aAnimals10aCardiac Pacing, Artificial10aFluorescent Dyes10aHeart Conduction System10aMembrane Potentials10aOptics and Photonics10aPericardium10aSignal Processing, Computer-Assisted10aTachycardia10aVentricular Function1 aDavidenko, J M1 aPertsov, A V1 aSalomonsz, R1 aBaxter, Bill1 aJalife, J uhttp://www.ncbi.nlm.nih.gov/pubmed/1552240