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The effects of remodeling with heart failure on mode of initiation of ventricular fibrillation and its spatiotemporal organization

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Abstract

Purpose

The effect of the heart failure substrate on the initiation of ventricular fibrillation (VF) and its resulting mechanism is not known. The objective of this study was to determine the effects of substrate on VF initiation and its spatiotemporal organization in the heart failure model.

Methods

Optical action potentials were recorded from LV wedge preparations either from structurally normal hearts (control, n = 11) or from congestive heart failure (CHF; n = 7), at the epicardial surface, endocardial surface which included a papillary muscle, and a transmural cross section. Action potential duration (APD80) was determined, and VF was initiated. A fast Fourier transform was calculated, and the dominant frequency (DF) was determined.

Results

The CHF group showed increased VF vulnerability (69 vs 26 %, p < 0.03), and every mapped surface showed an APD80 gradient which included islands of higher APDs on the transmural surface (M cells) which was not observed in controls. VF in the CHF group was characterized by stable, discrete, high-DF areas that correlated to either foci or spiral waves located on the transmural surface at the site of the papillary muscle. Overall, the top 10 % of DFs correlated to an APD of 101 ms while the bottom 10 % of DFs correlated to an APD of 126 ms (p < 0.01).

Conclusions

In the CHF model, APD gradients correlated with an increased vulnerability to VF, and the highest stable DFs were located on the transmural surface which was not seen in controls. This indicates that the CHF substrate creates unique APD and DF characteristics.

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Abbreviations

APD:

Action potential duration

BCL:

Basic cycle length

CHF:

Congestive heart failure

DF:

Dominant frequency

VF:

Ventricular fibrillation

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Acknowledgments

The authors would like to thank Changyu Shen, PhD, and Hongbo Lin for their help with the statistical analysis.

Author contributions

Thomas Everett was responsible for the concept and design of the experiments and collection of data, performed the data analysis and interpretation, and drafted the manuscript. George Hulley and Roger Chang were trainees who performed the data analysis and interpretation. Ken Lee assisted in the concept and design of the experiments and collection of data. Emily Wilson assisted in the concept and design of the experiments and collection of data. Jeffrey Olgin was responsible for the concept and design of the experiments, interpretation of the data, and generation of the manuscript.

Funding sources

This study received funding from the NIH grant RO1-HL072854 (JEO), RC1 HL099789 (JEO & THE), and AHA Western States Affiliate Beginning Grant-in-Aid 0765177Y (THE).

Conflict of interest

The authors declare that they have no competing interests.

Author information

Authors and Affiliations

  1. Krannert Institute of Cardiology, Indiana University School of Medicine, 1800 N. Capitol, Ste. E400E, Indianapolis, IN, 46202, USA

    Thomas H. Everett IV

  2. Division of Cardiology and the Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA

    George S. Hulley, Ken W. Lee, Roger Chang, Emily E. Wilson & Jeffrey E. Olgin

Authors
  1. Thomas H. Everett IV
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  2. George S. Hulley
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  3. Ken W. Lee
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Correspondence to Thomas H. Everett IV.

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Everett, T.H., Hulley, G.S., Lee, K.W. et al. The effects of remodeling with heart failure on mode of initiation of ventricular fibrillation and its spatiotemporal organization. J Interv Card Electrophysiol 43, 205–215 (2015). https://doi.org/10.1007/s10840-015-0016-2

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  • DOI: https://doi.org/10.1007/s10840-015-0016-2

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