title: Effect of global ischemia and reperfusion during ventricular fibrillation in myopathic human hearts.
abstract: The effect of lack of global coronary perfusion on myocardial activation rate, wavebreak, and its temporal progression during human ventricular fibrillation (VF) is not known. We tested the hypothesis that global myocardial ischemia decreases activation rate and spatiotemporal organization during VF in myopathic human hearts, while increasing wavebreak, and that a short duration of reperfusion can restore these spatiotemporal changes to baseline levels. The electrograms were acquired during VF in a human Langendorff model using global mapping consisting of two 112-electrode arrays placed on the epicardium and endocardium simultaneously. We found that global myocardial ischemia results in slowing of the global activation rate (combined endo and epi), from 4.89+/-0.04 Hz. to 3.60+/-0.04 Hz. during the 200 s of global ischemia (no coronary flow) (P<0.01) in eight myopathic hearts. Two minutes of reperfusion contributed to reversal of the slowing with activation rate value increasing close to VF onset (4.72+/-0.04 Hz). In addition, during the period of ischemia, an activation rate gradient between the endocardium (3.76+/-0.06 Hz) and epicardium (3.45+/-0.06 Hz) was observed (P<0.01). There was a concomitant difference in wavebreak index (that provides a normalized parameterization of phase singularities) between the epicardium (11.29+/-2.7) and endocardium (3.25+/-2.7) during the 200 s of ischemia (P=0.02). The activation rate, gradient, and wavebreak changes were reversed by short duration (2 min) of reperfusion. Global myocardial ischemia of 3 min leads to complex spatiotemporal changes during VF in myopathic human hearts; these changes can be reversed by a short duration of reperfusion.
authors.affiliation: Division of Cardiology, Toronto General Hospital, GW 3-522, 150 Gerrard St. West, Toronto, ON, Canada M5G 2C4.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Massé
authors.forename: Talha
authors.initials: T
authors.lastname: Farid
authors.forename: Paul
authors.initials: P
authors.lastname: Dorian
authors.forename: Karthikeyan
authors.initials: K
authors.lastname: Umapathy
authors.forename: Krishnakumar
authors.initials: K
authors.lastname: Nair
authors.forename: John
authors.initials: J
authors.lastname: Asta
authors.forename: Heather
authors.initials: H
authors.lastname: Ross
authors.forename: Vivek
authors.initials: V
authors.lastname: Rao
authors.forename: Elias
authors.initials: E
authors.lastname: Sevaptsidis
authors.forename: Kumaraswamy
authors.initials: K
authors.lastname: Nanthakumar
mesh_terms: D000200:Action Potentials; D000328:Adult; D009202:Cardiomyopathies / Q000150:complications* / Q000503:physiopathology; D003326:Coronary Circulation; D022062:Electrophysiologic Techniques, Cardiac; D004699:Endocardium / Q000503:physiopathology*; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000503:physiopathology; D015425:Myocardial Reperfusion; D010496:Pericardium / Q000503:physiopathology*; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000209:etiology* / Q000503:physiopathology