Role of papillary muscle in the generation and maintenance of reentry during ventricular tachycardia and fibrillation in isolated swine right ventricle

Young Hoon Kim, Fagen Xie, Masaaki Yashima, Tsu Juey Wu, Miguel Valderrábano, Moon Hyoung Lee, Toshihiko Ohara, Olga Voroshilovsky, Rahul N. Doshi, Michael C. Fishbein, Zhilin Qu, Alan Garfinkel, James N. Weiss, Hrayr S. Karagueuzian, Peng Sheng Chen

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Abstract

Background - The role of papillary muscle (PM) in the generation and maintenance of reentry is unclear. Methods and Results - Computerized mapping (477 bipolar electrodes, 1.6-mm resolution) was performed in fibrillating right ventricles (RVs) of swine in vitro. During ventricular fibrillation (VF), reentrant wave fronts often transiently anchored to the PM. Tissue mass reduction was then performed in 10 RVs until VF converted to ventricular tachycardia (VT). In an additional 6 RVs, procainamide infusion converted VF to VT. Maps showed that 77% (34 of 44) of all VT episodes were associated with a single reentrant wave front anchored to the PM. Purkinje fiber potentials preceded the local myocardial activation, and these potentials were recorded mostly around the PM. When PM was trimmed to the level of endocardium (n=4), sustained VT was no longer inducible. Transmembrane potential recordings (n=5) at the PM revealed full action potential during pacing, without evidence of ischemia. Computer simulation studies confirmed the role of PM as a spiral wave anchoring site that stabilized wave conduction. Conclusions - We conclude that PM is important in the generation and maintenance of reentry during VT and VF.

Original languageEnglish
Pages (from-to)1450-1459
Number of pages10
JournalCirculation
Volume100
Issue number13
DOIs
Publication statusPublished - 1999 Sep 28

Keywords

  • Antiarrhythmia agents
  • Death, sudden
  • Electrophysiology
  • Procainamide
  • Waves

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Kim, Y. H., Xie, F., Yashima, M., Wu, T. J., Valderrábano, M., Lee, M. H., Ohara, T., Voroshilovsky, O., Doshi, R. N., Fishbein, M. C., Qu, Z., Garfinkel, A., Weiss, J. N., Karagueuzian, H. S., & Chen, P. S. (1999). Role of papillary muscle in the generation and maintenance of reentry during ventricular tachycardia and fibrillation in isolated swine right ventricle. Circulation, 100(13), 1450-1459. https://doi.org/10.1161/01.CIR.100.13.1450