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Novel insights into the substrate involved in maintenance of ventricular fibrillation: results from continuous multipolar mapping in a canine model

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

While the triggers for ventricular fibrillation (VF) are well-known, the substrate required for its maintenance remains elusive. We have previously demonstrated dynamic spatiotemporal changes across VF from electrical induction of VF to asystole. Those data suggested that VF drivers seemed to reside in the distal RV and LV. However, signals from these areas were not recorded continuously. The aim of this study was to map these regions of significance with stationary basket electrodes from induction to asystole to provide further insights into the critical substrate for VF rhythm sustenance in canines.

Methods

In six healthy canines, three multipolar basket catheters were positioned in the distal right ventricle (RV), RV outflow tract, and distal left ventricle (LV), and remained in place throughout the study. VF was induced via direct current application from an electrophysiologic catheter. Surface and intracardiac electrograms were recorded simultaneously and continuously from baseline, throughout VF, and until asystole, in order to get a complete electrophysiologic analysis of VF. Focused data analysis was also performed via two defined stages of VF: early VF (immediately after induction of VF to 10 min) and late VF (after 10 min up to VF termination and asystole).

Results

VF was continuously mapped for a mean duration of 54 ± 9 min (range 42–70 min). Immediately after initiation of VF in the early phase, the distal LV region appeared to drive the maintenance of VF. Towards the terminal stage of VF, the distal RV region appeared to be responsible for VF persistence. In all canines, we noted local termination of VF in the LV, while VF on surface ECG continued; conversely, subsequent spontaneous termination of VF in the RV was associated with termination of VF on surface ECG into a ventricular escape rhythm. Continuous mapping of VF showed trends towards an increase in peak-to-peak ventricular electrogram cycle length (p = 0.06) and a decrease in the ventricular electrogram amplitude (p = 0.06) after 40 min. Once we could no longer discern surface QRS activity, we demonstrated local ventricular myocardial capture in both the RV and LV but could not reinitiate sustained VF despite aggressive ventricular burst pacing.

Conclusions

This study describes the evolution of VF from electrical initiation to spontaneous VF termination without hemodynamic support in healthy canines. These data are hypothesis-generating and suggest that critical substrate for VF maintenance may reside in both the distal RV and LV depending on stage of VF. Further studies are needed to replicate these findings with hemodynamic support and to translate such findings into clinical practice.

Graphical abstract

Ventricular fibrillation maintenance may be dependent on critical structures in the distal RV. ECG: electrocardiogram; LV: left ventricle; RV: right ventricle; RVOT: right ventricular outflow tract; VF: ventricular fibrillation

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Data availability

The data that support the findings of this paper are available from the corresponding author, [CVD], upon reasonable request.

Abbreviations

CL:

Cycle length

EAM:

Electroanatomic mapping

ECG:

Electrocardiogram

EGM:

Electrogram

EP:

Electrophysiology

HPS:

His-Purkinje system

ICD:

Implantable cardioverter-defibrillator

LV:

Left ventricle

PTSD:

Post-traumatic stress disorder

PVC:

Premature ventricular contraction

RI:

Regularity index

RV:

Right ventricle

RVOT:

Right ventricular outflow tract

SCD:

Sudden cardiac death

VF:

Ventricular fibrillation

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Acknowledgements

We would like to thank Renee Taubel and the veterinary staff of the Mayo Cardiovascular Innovations Laboratory for their contribution to conducting the animal experiments and Cory Scheuermann and Jamie Bush for their help with Rhythmia mapping.

Funding

This work was supported by the Earl A. Wood Career Development Benefactor Award to Dr. Christopher V. DeSimone, MD, PhD.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Fatima M. Ezzeddine, Robert C. Ward, Zhi Jiang, Jason A. Tri, Kolade Agboola, Tiffany Hu, Fahad Lodhi, Nicholas Y. Tan, Thomas P. Ladas, Georgios Christopoulos, Alan M. Sugrue, Freddy Del-Carpio Munoz, Samuel J. Asirvatham & Christopher V. DeSimone

  2. Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA

    Elena G. Tolkacheva

  3. Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, USA

    Christopher J. McLeod

  4. Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA

    Samuel J. Asirvatham

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  1. Fatima M. Ezzeddine
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Corresponding author

Correspondence to Christopher V. DeSimone.

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Ethical approval

This study was approved by the Mayo Clinic IACUC committee.

Conflict of interest

CVD, CJM, and SJA report patent filing for intellectual property related to novel tools and methods for ventricular fibrillation mapping and ablation.

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Ezzeddine, F.M., Ward, R.C., Jiang, Z. et al. Novel insights into the substrate involved in maintenance of ventricular fibrillation: results from continuous multipolar mapping in a canine model. J Interv Card Electrophysiol (2022). https://doi.org/10.1007/s10840-022-01333-7

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