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

Research output: Contribution to journalArticle

105 Citations (Scopus)

Abstract

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 fight 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.

Original languageEnglish (US)
Pages (from-to)839-848
Number of pages10
JournalCirculation research
Volume88
Issue number8
DOIs
StatePublished - Apr 27 2001

Fingerprint

Ventricular Fibrillation
Swine
Heart Ventricles
Papillary Muscles
Purkinje Fibers
Maintenance
Incidence

Keywords

  • Anisotropy
  • Fibrillation
  • Intramural reentry
  • Papillary muscle
  • Purkinje

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Dynamics of intramural and transmural reentry during ventricular fibrillation in isolated swine ventricles. / Valderrábano, Miguel; Lee, Moon Hyoung; Ohara, Toshihiko; Lai, Angela C.; Fishbein, Michael C.; Lin, Shien Fong; Karagueuzian, Hrayr S.; Chen, Peng Sheng.

In: Circulation research, Vol. 88, No. 8, 27.04.2001, p. 839-848.

Research output: Contribution to journalArticle

Valderrábano, Miguel ; Lee, Moon Hyoung ; Ohara, Toshihiko ; Lai, Angela C. ; Fishbein, Michael C. ; Lin, Shien Fong ; Karagueuzian, Hrayr S. ; Chen, Peng Sheng. / Dynamics of intramural and transmural reentry during ventricular fibrillation in isolated swine ventricles. In: Circulation research. 2001 ; Vol. 88, No. 8. pp. 839-848.
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AU - Valderrábano, Miguel

AU - Lee, Moon Hyoung

AU - Ohara, Toshihiko

AU - Lai, Angela C.

AU - Fishbein, Michael C.

AU - Lin, Shien Fong

AU - Karagueuzian, Hrayr S.

AU - Chen, Peng Sheng

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N2 - 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 fight 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.

AB - 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 fight 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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KW - Fibrillation

KW - Intramural reentry

KW - Papillary muscle

KW - Purkinje

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