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Dynamics of Intramural and Transmural Reentry During Ventricular Fibrillation in Isolated Swine Ventricles

 Miguel Valderrábano  ;  Moon-Hyoung Lee  ;  Toshihiko Ohara  ;  Angela C. Lai  ;  Michael C. Fishbein  ;  Shien-Fong Lin  ;  Hrayr S. Karagueuzian  ;  Peng-Sheng Chen 
 CIRCULATION RESEARCH, Vol.88(8) : 839-848, 2001 
Journal Title
Issue Date
Animals ; Anisotropy ; Body Surface Potential Mapping ; Connexins/metabolism ; Electrophysiologic Techniques, Cardiac ; Heart Conduction System/physiopathology* ; Heart Ventricles/physiopathology* ; In Vitro Techniques ; Myocardium/metabolism ; Optics and Photonics ; Papillary Muscles/physiopathology ; Purkinje Fibers/metabolism ; Swine ; Ventricular Dysfunction, Left/physiopathology ; Ventricular Dysfunction, Right/physiopathology ; Ventricular Fibrillation/physiopathology*
intramural reentry ; fibrillation ; anisotropy ; purkinje ; papillary muscle
The intramural dynamics of ventricular fibrillation (VF) remain poorly understood. Recent investigations have suggested that stable intramural reentry may underlie the mechanisms of VF. We performed optical mapping studies of VF in isolated swine right ventricles (RVs) and left ventricles (LVs). Nine RV walls were cut obliquely in their distal edge exposing the transmural surface. Six LV wedge preparations were also studied. Results showed that intramural reentry was present. In RV, 28 of 44 VF episodes showed reentry; 15% of the activation pathways were reentrant. Except for 4 episodes, reentry was transmural, involving subendocardial structures as the papillary muscle (PM) or trabeculae. In LV, reentry was observed in 27 of 27 VF episodes; 23% of the activations were part of reentrant pathways (P<0.05 compared with RV). All LV reentrant pathways were truly intramural (confined to the wall) and were frequently located at the PM insertion. In both ventricles, reentry was spatially and temporally unstable. Histological studies showed abrupt changes in fiber orientation at sites of reentry and wave splitting. Connexin 40 immunostaining demonstrated intramyocardial Purkinje fibers at sites of reentry in the PM root and around endocardial trabeculae. Our results confirm that reentry is frequent-but unstable-in the myocardial wall during VF. In RV, reentry is mostly transmural and requires participation of subendocardial structures. The LV has a greater incidence of reentry and is intramural. Anisotropic anatomic structures played key roles in the generation of wave splitting and in the maintenance of reentry.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Lee, Moon-Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
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