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Nonstationary vortexlike reentrant activity as a mechanism of polymorphic ventricular tachycardia in the isolated rabbit heart

(1995) CIRCULATION. 91(9). p.2454-2469
Author
Organization
Abstract
Background: Ventricular tachycardia may result from vortexlike reentrant excitation of the myocardium. Our general hypothesis is that in the structurally normal heart, these arrhythmias are the result of one or two nonstationary three-dimensional electrical scroll waves activating the heart muscle at very high frequencies. Methods and Results: We used a combination of high-resolution video imaging, electrocardiography, and image processing in the isolated rabbit heart, together with mathematical modeling. We characterized the dynamics of changes in transmembrane potential patterns on the epicardial surface of the ventricles using optical mapping. Image processing techniques were used to identify the surface manifestation of the reentrant organizing centers, and the location of these centers was used to determine the movement of the reentrant pathway. We also used numerical simulations incorporating Fitzhugh-Nagumo kinetics and realistic heart geometry to study how stationary and nonstationary scroll waves are manifest on the epicardial surface and in the simulated EGG. We present epicardial surface manifestations (reentrant spiral waves) and ECG patterns of nonstationary reentrant activity that are consistent with those generated by scroll waves established at the right and left ventricles. We identified the organizing centers of the reentrant circuits on the epicardial surface during polymorphic tachycardia, and these centers moved during the episodes. In addition, the arrhythmias that showed the greatest movement of the reentrant centers displayed the largest changes in QRS morphology. The numerical simulations showed that stationary scroll waves give rise to monomorphic ECG signals, but nonstationary meandering scroll waves give rise to undulating ECGs characteristic of torsade de pointes. Conclusions: Polymorphic ventricular tachycardia in the healthy, isolated rabbit heart is the result of either a single or paired (''figure-of-eight'') nonstationary scroll waves, The extent of the scroll wave movement corresponds to the degree of polymorphism in the EGG. These results are consistent with our numerical simulations that showed monomorphic ECG patterns of activity for stationary scroll waves but polymorphic patterns for scroll waves that were nonstationary.
Keywords
MYOCARDIAL-INFARCTION, ACTIVATION PATTERNS, EXCITABLE MEDIA, CIRCUS, MOVEMENT, CARDIAC-MUSCLE, CANINE HEARTS, ATRIAL MUSCLE, SPIRAL WAVES, ARRHYTHMIAS, EXCITATION, TACHYCARDIA, REENTRY, ARRHYTHMIA, TORSADE DE POINTES

Citation

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Chicago
Gray, RA, J Jalife, Alexander Panfilov, WT Baxter, C Cabo, JM Davidenko, and AM Pertsov. 1995. “Nonstationary Vortexlike Reentrant Activity as a Mechanism of Polymorphic Ventricular Tachycardia in the Isolated Rabbit Heart.” Circulation 91 (9): 2454–2469.
APA
Gray, R., Jalife, J., Panfilov, A., Baxter, W., Cabo, C., Davidenko, J., & Pertsov, A. (1995). Nonstationary vortexlike reentrant activity as a mechanism of polymorphic ventricular tachycardia in the isolated rabbit heart. CIRCULATION, 91(9), 2454–2469.
Vancouver
1.
Gray R, Jalife J, Panfilov A, Baxter W, Cabo C, Davidenko J, et al. Nonstationary vortexlike reentrant activity as a mechanism of polymorphic ventricular tachycardia in the isolated rabbit heart. CIRCULATION. 1995;91(9):2454–69.
MLA
Gray, RA et al. “Nonstationary Vortexlike Reentrant Activity as a Mechanism of Polymorphic Ventricular Tachycardia in the Isolated Rabbit Heart.” CIRCULATION 91.9 (1995): 2454–2469. Print.
@article{8608636,
  abstract     = {Background: Ventricular tachycardia may result from vortexlike reentrant excitation of the myocardium. Our general hypothesis is that in the structurally normal heart, these arrhythmias are the result of one or two nonstationary three-dimensional electrical scroll waves activating the heart muscle at very high frequencies. 
Methods and Results: We used a combination of high-resolution video imaging, electrocardiography, and image processing in the isolated rabbit heart, together with mathematical modeling. We characterized the dynamics of changes in transmembrane potential patterns on the epicardial surface of the ventricles using optical mapping. Image processing techniques were used to identify the surface manifestation of the reentrant organizing centers, and the location of these centers was used to determine the movement of the reentrant pathway. We also used numerical simulations incorporating Fitzhugh-Nagumo kinetics and realistic heart geometry to study how stationary and nonstationary scroll waves are manifest on the epicardial surface and in the simulated EGG. We present epicardial surface manifestations (reentrant spiral waves) and ECG patterns of nonstationary reentrant activity that are consistent with those generated by scroll waves established at the right and left ventricles. We identified the organizing centers of the reentrant circuits on the epicardial surface during polymorphic tachycardia, and these centers moved during the episodes. In addition, the arrhythmias that showed the greatest movement of the reentrant centers displayed the largest changes in QRS morphology. The numerical simulations showed that stationary scroll waves give rise to monomorphic ECG signals, but nonstationary meandering scroll waves give rise to undulating ECGs characteristic of torsade de pointes. 
Conclusions: Polymorphic ventricular tachycardia in the healthy, isolated rabbit heart is the result of either a single or paired (''figure-of-eight'') nonstationary scroll waves, The extent of the scroll wave movement corresponds to the degree of polymorphism in the EGG. These results are consistent with our numerical simulations that showed monomorphic ECG patterns of activity for stationary scroll waves but polymorphic patterns for scroll waves that were nonstationary.},
  author       = {Gray, RA and Jalife, J and Panfilov, Alexander and Baxter, WT and Cabo, C and Davidenko, JM and Pertsov, AM},
  issn         = {0009-7322},
  journal      = {CIRCULATION},
  keywords     = {MYOCARDIAL-INFARCTION,ACTIVATION PATTERNS,EXCITABLE MEDIA,CIRCUS,MOVEMENT,CARDIAC-MUSCLE,CANINE HEARTS,ATRIAL MUSCLE,SPIRAL WAVES,ARRHYTHMIAS,EXCITATION,TACHYCARDIA,REENTRY,ARRHYTHMIA,TORSADE DE POINTES},
  language     = {eng},
  number       = {9},
  pages        = {2454--2469},
  title        = {Nonstationary vortexlike reentrant activity as a mechanism of polymorphic ventricular tachycardia in the isolated rabbit heart},
  url          = {http://dx.doi.org/10.1161/01.CIR.91.9.2454},
  volume       = {91},
  year         = {1995},
}

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