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Mechanisms of ventricular fibrillation induction by 60-Hz alternating current in isolated swine right ventricle

 Voroshilovsky, Olga  ;  Qu, Zhilin  ;  Lee, Moon-Hyoung  ;  Ohara, Toshihiko  ;  Fishbein, Gregory A.  ;  Huang, Hsun-Lun A.  ;  Swerdlow, Charles D.  ;  Lin, Shien-Fong  ;  Garfinkel, Alan  ;  Weiss, James N.  ;  Karagueuzian, Hrayr S.  ;  Chen, Peng-Sheng 
 Circulation, Vol.102(13) : 1569-1574, 2000 
Journal Title
Issue Date
Animals ; Electricity/adverse effects* ; Heart Ventricles/physiopathology ; Swine ; Time Factors ; Ventricular Fibrillation/etiology* ; Ventricular Fibrillation/physiopathology
BACKGROUND: The mechanisms by which 60-Hz alternating current (AC) can induce ventricular fibrillation (VF) are unknown. METHODS AND RESULTS: We studied 7 isolated perfused swine right ventricles in vitro. The action potential duration restitution curve was determined. Optical mapping techniques were used to determine the patterns of activation on the epicardium during 5-second 60-Hz AC stimulation (10 to 999 microA). AC captured the right ventricles at 100+/-65 microA, which is significantly lower than the direct current pacing threshold (0.77+/-0.45 mA, P:<0.05). AC induced ventricular tachycardia or VF at 477+/-266 microA, when the stimulated responses to AC had (1) short activation CLs (128+/-14 ms), (2) short diastolic intervals (16+/-9 ms), and (3) short diastolic intervals associated with a steep action potential duration restitution curve. Optical mapping studies showed that during rapid ventricular stimulation by AC, a wave front might encounter the refractory tail of an earlier wave front, resulting in the formation of a wave break and VF. Computer simulations reproduced these results. CONCLUSIONS: AC at strengths less than the regular pacing threshold can capture the ventricle at fast rates. Accidental AC leak to the ventricles could precipitate VF and sudden death if AC results in a fast ventricular rate coupled with a steep restitution curve and a nonuniform recovery of excitability of the myocardium.
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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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