title: Regional differences in the dynamics of refractoriness in intact and hypertrophied in situ canine hearts.
abstract: OBJECTIVE
  Functional re-entry is thought to represent the predominant mechanism underlying ventricular arrhythmias. Functional conduction block may be caused by regional dispersion of refractoriness (ERP). Dispersion of ERP may not be evident at baseline, but may occur with sudden changes in heart rate, as ventricular arrhythmias are commonly induced by short-long-short cycles.
  
  
  METHODS
  We examined the dynamics of local ERPs at two left ventricular (LV) sites in dogs with either no structural heart disease or biventricular hypertrophy (BVH). ERPs were determined at each of four bipoles of two adjacent needle electrodes in the LV apex and the lateral wall. The stimulation protocol included two different basic cycle lengths, one or two longer cycles after a train of 6 or 5 shorter cycles, and one shorter cycle after a train of 6 longer cycles.
  
  
  RESULTS
  In normal dogs, a significant apicolateral ERP gradient was only evident with the longer basic cycle length. One shorter cycle was sufficient to dissolve that gradient. One longer cycle was enough to create a regional ERP gradient. Dynamic regional gradients occurred because the apex responded more markedly and more readily to abrupt changes in cycle length. BVH led to an increase in ERP at both LV sites and to an aggravation of regional ERP gradients.
  
  
  CONCLUSIONS
  Dynamic ERP behavior seems to depend on topography and underlying pathology. Abrupt changes in heart rate might induce dynamic refractory gradients between various regions of the normal heart, but also between adjacent regions inhomogenously affected by hypertrophy.
authors.affiliation: University of Heidelberg, Department of Cardiology, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany. Frederik_Voss@med.uni-heidelberg.de
authors.forename: F
authors.initials: F
authors.lastname: Voss
authors.forename: W
authors.initials: W
authors.lastname: Schoels
authors.forename: J
authors.initials: J
authors.lastname: Lue
authors.forename: A
authors.initials: A
authors.lastname: Bauer
authors.forename: H A
authors.initials: HA
authors.lastname: Katus
authors.forename: R
authors.initials: R
authors.lastname: Becker
mesh_terms: D000818:Animals; D006332:Cardiomegaly / Q000503:physiopathology*; D004285:Dogs; D005260:Female; D006321:Heart / Q000503:physiopathology*; D008297:Male; D012032:Refractory Period, Electrophysiological