Dynamic and not static change in ventricular repolarization is a substrate of ventricular arrhythmia on chronic ischemic myocardium

doi:10.1016/j.cardiores.2004.04.017

Cardiovascular Research 2004 63(4):645-652; doi:10.1016/j.cardiores.2004.04.017
© 2004 by European Society of Cardiology

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Dynamic and not static change in ventricular repolarization is a substrate of ventricular arrhythmia on chronic ischemic myocardium

Kouichi Yuuki^a, Yukio Hosoya^b, Isao Kubota^a and Michiyasu Yamaki^*^,b

^aDivision of Cardiology, Pulmonology, and Nephrology, Department of Internal Medicine and Therapeutics, Yamagata University School of Medicine, Yamagata 990-9585, Japan
^bDivision of Medical Informatics, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan

^* Corresponding author. Tel.: +81-23-628-5845; fax: +81-23-628-5847. Email address: myamaki{at}med.id.yamagata-u.ac.jp

Objective: The restitution mechanism has been the focus of attentionas the possible mechanism behind ventricular fibrillation (VF).However, its contribution in chronic ischemic heart has notbeen established. Methods: We investigated chronic ischemicdogs with occlusion of left anterior descending artery. Sixtyunipolar electrograms were simultaneously recorded from an entirecardiac surface. Activation-recovery intervals (ARIs) and QRSTdeflection area (AQRST) were measured during constant atrialpacing. The ischemic dogs were divided into two groups, fivedogs in VF(+) group or seven dogs in VF(–) group, accordingto VF occurrence by programmed electrical stimulation. Results:When investigating ARI dispersions on an epicardium, there wasno difference between VF(+) and VF(–) groups. The relationshipbetween ARIs and diastolic intervals was quantified as an electricalrestitution curve. The slopes of the ARI restitution curve forthe anterior left ventricle in VF(+) dogs were significantlysteeper than those of VF(–) dogs. The amplitude of AQRSTalternans were significantly greater in VF(+) dogs than VF(–)dogs. Conclusions: Combined observation of steep restitutionslopes and increased electrical alternans supported the restitutionmechanism as being involved in the arrhythmia. Dynamic restitutionproperties and not static single-beat ARI dispersion may playan important role in the VF arrhythmia in the chronic ischemicheart.

KEYWORDS Ischemia; Myocardial infarction; Tachyarrhythmia; Electrophysiology

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