Termination of ventricular tachycardia in the human heart. Insights
from three-dimensional mapping of nonsustained and sustained ventricular
tachycardias.
BACKGROUND: To define the electrophysiological basis for the termination
of ventricular tachycardia (VT), three-dimensional cardiac mapping
and analysis of the terminal beats of nonsustained VT and beats of
sustained VT were performed in six patients with healed myocardial
infarcts. METHODS AND RESULTS: Termination of VT was due to activation
from multiple initiation sites that were discordant from those responsible
for the maintenance of sustained VT in 45\% of cases, to repetitive
activation from single sites that were discordant from those responsible
for the maintenance of sustained VT in 24\% of cases, or to activation
from sites concordant with the sites of repetitive activation during
sustained VT in 31\% of cases. Sustained VT was characterized by
occasional shifting of initiation sites, even after the tachycardia
entered the stable monomorphic phase. Mapping was of sufficient density
to define the mechanisms for 21 terminating beats of VT. In 5 cases,
termination was due to intramural reentry, which initiated with the
total activation time of the preceding beat of 204 +/- 11 milliseconds
(ms) but terminated primarily because of a decrease in total activation
time (144 +/- 23 ms, P = .03) that was associated with the development
of intramural conduction block or with significant changes in the
activation sequence along the reentrant circuit. In 16 cases, terminal
beats were initiated by a focal mechanism on the basis of the absence
of intervening electrical activity from the termination of the preceding
beat to the initiation of the terminating beat (172 +/- 9 ms). Focal
activation was associated with less conduction delay of the preceding
beat (115 +/- 6 ms) than terminating reentrant beats (P < .001) and
usually terminated suddenly without oscillations in cycle length
or total activation time. CONCLUSIONS: Termination of VT is associated
with alterations in initiation sites that are most often discordant
from those maintaining sustained VT and is due to either reentrant
or focal mechanisms.
%0 Journal Article
%1 Pogw_1997_2528
%A Pogwizd, S. M.
%A Chung, M. K.
%A Cain, M. E.
%D 1997
%J Circulation
%K 't, 3-Monooxygenase, 9184583 Angina Animals, Blood Bradykini, Conduction Dogs, Electrocardiography, Electrophysiology, Factors, Fibers, Gov't, Gov, Heart Heart, Humans, Immunoblotting, Ischemia, Laser Myocardial Myocardium, Nerve Non-U.S. P.H.S., Pectoris, Pressure, Research Support, Surgery, Sympathectomy, System, Tachycardia, Time Tyrosine U.S. Ventricular, n,
%N 11
%P 2528--2540
%T Termination of ventricular tachycardia in the human heart. Insights
from three-dimensional mapping of nonsustained and sustained ventricular
tachycardias.
%U http://circ.ahajournals.org/cgi/content/full/95/11/2528
%V 95
%X BACKGROUND: To define the electrophysiological basis for the termination
of ventricular tachycardia (VT), three-dimensional cardiac mapping
and analysis of the terminal beats of nonsustained VT and beats of
sustained VT were performed in six patients with healed myocardial
infarcts. METHODS AND RESULTS: Termination of VT was due to activation
from multiple initiation sites that were discordant from those responsible
for the maintenance of sustained VT in 45\% of cases, to repetitive
activation from single sites that were discordant from those responsible
for the maintenance of sustained VT in 24\% of cases, or to activation
from sites concordant with the sites of repetitive activation during
sustained VT in 31\% of cases. Sustained VT was characterized by
occasional shifting of initiation sites, even after the tachycardia
entered the stable monomorphic phase. Mapping was of sufficient density
to define the mechanisms for 21 terminating beats of VT. In 5 cases,
termination was due to intramural reentry, which initiated with the
total activation time of the preceding beat of 204 +/- 11 milliseconds
(ms) but terminated primarily because of a decrease in total activation
time (144 +/- 23 ms, P = .03) that was associated with the development
of intramural conduction block or with significant changes in the
activation sequence along the reentrant circuit. In 16 cases, terminal
beats were initiated by a focal mechanism on the basis of the absence
of intervening electrical activity from the termination of the preceding
beat to the initiation of the terminating beat (172 +/- 9 ms). Focal
activation was associated with less conduction delay of the preceding
beat (115 +/- 6 ms) than terminating reentrant beats (P < .001) and
usually terminated suddenly without oscillations in cycle length
or total activation time. CONCLUSIONS: Termination of VT is associated
with alterations in initiation sites that are most often discordant
from those maintaining sustained VT and is due to either reentrant
or focal mechanisms.
@article{Pogw_1997_2528,
abstract = {BACKGROUND: To define the electrophysiological basis for the termination
of ventricular tachycardia (VT), three-dimensional cardiac mapping
and analysis of the terminal beats of nonsustained VT and beats of
sustained VT were performed in six patients with healed myocardial
infarcts. METHODS AND RESULTS: Termination of VT was due to activation
from multiple initiation sites that were discordant from those responsible
for the maintenance of sustained VT in 45\% of cases, to repetitive
activation from single sites that were discordant from those responsible
for the maintenance of sustained VT in 24\% of cases, or to activation
from sites concordant with the sites of repetitive activation during
sustained VT in 31\% of cases. Sustained VT was characterized by
occasional shifting of initiation sites, even after the tachycardia
entered the stable monomorphic phase. Mapping was of sufficient density
to define the mechanisms for 21 terminating beats of VT. In 5 cases,
termination was due to intramural reentry, which initiated with the
total activation time of the preceding beat of 204 +/- 11 milliseconds
(ms) but terminated primarily because of a decrease in total activation
time (144 +/- 23 ms, P = .03) that was associated with the development
of intramural conduction block or with significant changes in the
activation sequence along the reentrant circuit. In 16 cases, terminal
beats were initiated by a focal mechanism on the basis of the absence
of intervening electrical activity from the termination of the preceding
beat to the initiation of the terminating beat (172 +/- 9 ms). Focal
activation was associated with less conduction delay of the preceding
beat (115 +/- 6 ms) than terminating reentrant beats (P < .001) and
usually terminated suddenly without oscillations in cycle length
or total activation time. CONCLUSIONS: Termination of VT is associated
with alterations in initiation sites that are most often discordant
from those maintaining sustained VT and is due to either reentrant
or focal mechanisms.},
added-at = {2009-06-03T11:20:58.000+0200},
author = {Pogwizd, S. M. and Chung, M. K. and Cain, M. E.},
biburl = {https://www.bibsonomy.org/bibtex/27dabb79044b3c7e9b7cb97ee02f8d1ec/hake},
description = {The whole bibliography file I use.},
interhash = {2df7f0acec1373a167626fcb9dfe1e11},
intrahash = {7dabb79044b3c7e9b7cb97ee02f8d1ec},
journal = {Circulation},
keywords = {'t, 3-Monooxygenase, 9184583 Angina Animals, Blood Bradykini, Conduction Dogs, Electrocardiography, Electrophysiology, Factors, Fibers, Gov't, Gov, Heart Heart, Humans, Immunoblotting, Ischemia, Laser Myocardial Myocardium, Nerve Non-U.S. P.H.S., Pectoris, Pressure, Research Support, Surgery, Sympathectomy, System, Tachycardia, Time Tyrosine U.S. Ventricular, n,},
month = Jun,
number = 11,
pages = {2528--2540},
pmid = {9184583},
timestamp = {2009-06-03T11:21:26.000+0200},
title = {Termination of ventricular tachycardia in the human heart. Insights
from three-dimensional mapping of nonsustained and sustained ventricular
tachycardias.},
url = {http://circ.ahajournals.org/cgi/content/full/95/11/2528},
volume = 95,
year = 1997
}