Document Detail

Characteristics of wave fronts during ventricular fibrillation in human hearts with dilated cardiomyopathy: role of increased fibrosis in the generation of reentry.
MedLine Citation:
PMID:  9669269     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: We sought to evaluate the characteristics of wave fronts during ventricular fibrillation (VF) in human hearts with dilated cardiomyopathy (DCM) and to determine the role of increased fibrosis in the generation of reentry during VF. BACKGROUND: The role of increased fibrosis in reentry formation during human VF is unclear. METHODS: Five hearts from transplant recipients with DCM were supported by Langendorff perfusion and were mapped during VF. A plaque electrode array with 477 bipolar electrodes (1.6-mm resolution) was used for epicardial mapping. In heart no. 5, we also used 440 transmural bipolar recordings. Each mapped area was analyzed histologically. RESULTS: Fifteen runs of VF (8 s/run) recorded from the epicardium were analyzed, and 55 episodes of reentry were observed. The life span of reentry was short (one to four cycles), and the mean cycle length was 172 +/- 24 ms. In heart no. 5, transmural scroll waves were demonstrated. The most common mode of initiation of reentry was epicardial breakthrough, followed by a line of conduction block parallel to the epicardial fiber orientation (34 [62%] of 55 episodes). In the areas with lines of block, histologic examination showed significant fibrosis separating the epicardial muscle fibers and bundles along the longitudinal axis of fiber orientation. The mean percent fibrous tissue in these areas (n = 20) was significantly higher than that in the areas without block (n = 28) (24 +/- 7.5% vs. 10 +/- 3.8%, p < 0.0001). CONCLUSIONS: In human hearts with DCM, epicardial reentrant wave fronts and transmural scroll waves were present during VF. Increased fibrosis provides a site for conduction block, leading to the continuous generation of reentry.
T J Wu; J J Ong; C Hwang; J J Lee; M C Fishbein; L Czer; A Trento; C Blanche; R M Kass; W J Mandel; H S Karagueuzian; P S Chen
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  32     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1998 Jul 
Date Detail:
Created Date:  1998-07-22     Completed Date:  1998-07-22     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  187-96     Citation Subset:  AIM; IM    
Department of Medicine, Burns and Allen Research Institute, Cedars-Sinai Medical Center and University of California Los Angeles School of Medicine, 90048, USA.
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MeSH Terms
Atrioventricular Node / pathology,  physiopathology
Cardiac Pacing, Artificial
Cardiomyopathy, Dilated / diagnosis,  pathology,  physiopathology*
Endocardium / pathology,  physiopathology
Endomyocardial Fibrosis / diagnosis,  pathology,  physiopathology*
Heart Transplantation / physiology
Pericardium / pathology,  physiopathology
Signal Processing, Computer-Assisted
Tachycardia, Atrioventricular Nodal Reentry / diagnosis,  pathology,  physiopathology*
Ventricular Fibrillation / pathology,  physiopathology*
Grant Support

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