Mechanisms of recurrent ventricular fibrillation in a rabbit model of pacing-induced heart failure.
BACKGROUND
Successful defibrillation may be followed by recurrent spontaneous ventricular fibrillation (VF). The mechanisms of postshock spontaneous VF are unclear.


OBJECTIVE
The purpose of this study was to determine the mechanisms of spontaneous VF after initial successful defibrillation in a rabbit model of heart failure (HF).


METHODS
Simultaneous optical mapping of intracellular calcium (Ca(i)) and membrane potential (Vm) was performed in 12 rabbit hearts with chronic pacing-induced heart failure, in 4 sham-operated hearts, and in 5 normal hearts during fibrillation-defibrillation episodes.


RESULTS
Twenty-eight spontaneous VF episodes were recorded after initial successful defibrillation in 4 failing hearts (SVF group) but not in the remaining 8 failing hearts (no-SVF group) or in the normal or sham-operated hearts. The action potential duration (APD(80)) before pacing-induced VF was 209 +/- 9 ms in the SVF group and 212 +/- 14 ms in the no-SVF group (P = NS). After successful defibrillation, APD(80) shortened to 147 +/- 26 ms in the SVF group and to 176 +/- 14 ms in the no-SVF group (P = .04). However, the duration of Ca(i) after defibrillation was not different between the two groups (246 +/- 21 ms vs 241 +/- 17 ms, P = NS), resulting in elevated Ca(i) during late phase 3 or phase 4 of the action potential. Standard glass microelectrode recording in an additional 5 failing hearts confirmed postshock APD shortening and afterdepolarizations. APD(80) of normal and sham-operated hearts was not shortened after defibrillation.


CONCLUSIONS
HF promotes acute shortening of APD immediately after termination of VF in failing hearts. Persistent Ca(i) elevation during late phase 3 and phase 4 of the shortened action potential result in afterdepolarizations, triggered activity, and spontaneous VF.
Ogawa
Masahiro
M
Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Morita
Norishige
N
Tang
Liang
L
Karagueuzian
Hrayr S
HS
Weiss
James N
JN
Lin
Shien-Fong
SF
Chen
Peng-Sheng
PS
D000200:Action Potentials; D000818:Animals; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects*; D004195:Disease Models, Animal; D006333:Heart Failure / Q000150:complications*; D011817:Rabbits; D012008:Recurrence; D014693:Ventricular Fibrillation / Q000209:etiology* / Q000503:physiopathology*