Skip to main content
SpringerLink
Log in

Electrophysiologic mechanisms of ventricular arrhythmias

  • Published:
The International Journal of Cardiac Imaging Aims and scope Submit manuscript

Abstract

In this work the electrophysiologic mechanisms of ventricular arrhythmias have been briefly summarized. Ventricular arrhytmias can be caused either by pacemaker activity or by reentrant excitation. Enhancement of normal automaticy can generate a parasystolic rhythm in normal fibers. Abnormal automaticity may arise fom fibers in which maximum diastolic potential has been reduced by a variety of interventions. Triggered activity is caused by either an early (EAD) or delayed (DAD) afterdepolarization and requires a prior normal action potential for initiation. While there is growing evidence that EAD-induced triggered activity plays a significant role in the Long QTU syndrome and Torsade de Pointes, no clinical arrhythmias has definitely been ascribed to DADs, although DADs have been recorded in man after acute digoxin intoxication.

Ventricular arrhytmias can be also caused by reentrant excitation, which can be subdivided into reflection or circus movement reentry (CMR). In the reflection model impulses in both directions are transmitted over the same pathway. In the CMR three models can be differentiated: the ring model, which requires a fixed anatomical obstacle; the figure-eight model and the leading circle model, where functional rather than fixed anatomical obstacles are involved.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

AV:

atrio-ventricular

CMR:

circus movement reentry

DAD:

delayed afterdepolarization

EAD:

early afterdepolarization

ECG:

electrocardiogram

LV:

left ventricle

MAP:

monophasic action potential

MF:

muscle fiber

PF:

Purkinje fiber

RV:

right ventricle

TdP:

Torsade de Pointes

References

  1. Hoffman BF, Rosen MR. Cellular mechanisms of cardiac arrhythmias. Circ Res 1981; 49: 1.

    Google Scholar 

  2. Cranefield PF, Aronson RS. Cardiac Arrhythmias: The role of triggered activity and other mechanisms. Mount Kisco, NY: Futura Publ Co., 1988.

    Google Scholar 

  3. Wit AL, Cranefield PF. Reentrant excitation as a cause of cardiac arrhythmias. Am J Physiol 1978; 235: Hl.

  4. Antzelevitch C, Jalife F, Moe GK. Characteristics of reflection as a mechanism of reentrant arrhythmias and its relationship to parasystole. Circulation 1980; 61: 182.

    Google Scholar 

  5. Vassalle M. The relationship among cardiac pacemakers: overdrive suppression. Circ Res 1977; 41: 269.

    Google Scholar 

  6. Jalife J, Moe GK. Effects of electrotonic potentials on pacemaker activity of canine Purkinje fibers in relation to parasystole. Circ Res 1976; 39: 801.

    Google Scholar 

  7. Hauswirth O, Noble P, Tsien RW. The mechanism of oscillatory activity at low membrane potentials in cardiac Purkinkje fibers. J Physiol (Lond) 1969; 200: 255.

    Google Scholar 

  8. Katzung BO, Morgenstern JA. Effects of extracellular potassium on ventricular automaticity and evidence for a pacemaker current in mammalian ventricular myocardium. Circ Res 1977; 40: 105.

    Google Scholar 

  9. Noble D, Tsien RW. The kinetics and rectifier properties of the slow potassium current in cardiac Purkinje fibers. J Physiol (Lond), 1968; 195: 185.

    Google Scholar 

  10. Ferrier GR, Rosenthal JE. Automaticity and entrance block induced by focal depolarization of mammalian ventricular tissues. Circ Res 1980; 47: 238.

    Google Scholar 

  11. Hoffman BF, Dangman KH. Are arrhythmias caused by automatic impulse generation? In: Paes de Varvalho A, Hoffman BF, Liberman M, editors. Normal and Abnormal Conduction in the Heart. Mt. Kisco (N.Y.): Futura, 1982: 152–63.

    Google Scholar 

  12. Friedman PL, Stewart JR, Wit AL. Spontaneous and induced cardiac arrhythmias in subendocardial Purkinje fibers surviving extensive myocardial infarction in dogs. Circ Res 1973; 33: 612.

    Google Scholar 

  13. Lazzara R, El-Sherif N, Scherlag BJ. Electrophysiological properties of canine Purkinje cells in one-day-old myocardial infarction. Circ Res 1973; 33: 722.

    Google Scholar 

  14. El-Sherif N, Gough WB, Zeiler RH, Mehra R. Triggered ventricular rhythms in 1-day-old myocardial infarction in the dog. Circ Res 1983; 52: 566.

    Google Scholar 

  15. Isenberg G, Ravens U. The effects of anemonia sulcata toxin (ATX II) on membrane currents of isolated mammalian myocytes. J Physiol 1984; 357: 127–49.

    Google Scholar 

  16. El-Sherif N, Craelius W, Boutjdir M, Gough W. Early afterdepolarizations and arrhythmogenesis. J Cardiovasc Electrophysiology 1990; 1(2): 145–60.

    Google Scholar 

  17. Noble D. Ionic bases of rhythmic activity in the heart. In: Zipes DP, Jalife J, editors. Cardiac Electrophysiology and Arrhythmias. Orlando (Fla): Grune & Stratton, 1985: 3–12.

    Google Scholar 

  18. Jackman WM, Clark M, Friday KJ, Aliot EM, Anderson J, Lazzara R. Ventricular tachyarrhythmias in the long QT syndrome. Med Clin North Amer 1984; 68: 1079–104.

    Google Scholar 

  19. Stratmann HG, Kennedy HL. Torsades de Pointes associated with drugs and toxins: recognition and management. Am Heart J 1989; 113: 1470.

    Google Scholar 

  20. Bonatti V, Roli A, Botti G. Recording of monophasic action potentials of the right ventricle in long QT syndromes complicated by severe ventricular arrhythmias. Eur Heart J 1983; 4: 168–79.

    Google Scholar 

  21. El-Sherif N, Bekheit SS, Henkin R. Quinidine-induced long QTU interval and Torsade de Pointes: role of brady-cardia-dependent early afterdepolarizations. J Am Cell Cardiol 1989; 14: 252–7.

    Google Scholar 

  22. Habbab MA, El-Sherif N. Drug-induced Torsade de Pointes. Role of early afterdepolarizations and dispersion of repolarization. Am J Med 1980; 89: 241.

    Google Scholar 

  23. January GT, Fozzard HA. Delayed afterdepolarizations in heart muscle. Mechanisms and relevance. Pharmacol Rev 1988; 40: 219.

    Google Scholar 

  24. Boutjdir M, El-Sherif N, Gough WB. Effects of caffeine and ryanodine on delayed afterdepolarizations and sustained rhythmic activity in 1-day-old myocardial infarction in the dog. Circulation 1990; 81: 1393.

    Google Scholar 

  25. El-Sherif N, Gough WB, Restivo M, Boutjdir M. Electrophysiology of ventricular arrhythmias in myocardial ischemia and infarction. In: El-Sherif N, Samet P, editors. Cardiac pacing and electrophysiology. WB Saunders, 1990: 18–56.

  26. El-Sherif N. Reentry revisited. Pace 1988; 11: 1358.

    Google Scholar 

  27. Mayer AG. Rhythmical pulsation in Scyphomedusae: II. Carnegie Institute. Papers. Washington Tortugas Lab 1: 113–31. Carnegie Institute Publication 1908, no 102, part VII.

  28. Garrey WE. The nature of fibrillary contraction of the heart. Its relation to tissue mass and form. Am J Physiol 1914; 33: 497.

    Google Scholar 

  29. Mines GR. On dynamic equilibrium in the heart. J Physiol 1913; 46: 350.

    Google Scholar 

  30. Mines GR. On circulating excitation in heart muscle and their possible relation to tachycardia and fibrillation. Trans R Soc Can 1914; 8: 43.

    Google Scholar 

  31. Lewis T, Feil HS, Stroud WD. Observations upon flutter and fibrillation. Part II, the nature of auricular flutter. Heart 1920; 7: 191.

    Google Scholar 

  32. Schmitt FO, Erlanger J. Directional differences in the conduction of the impulse through heart muscle and their possible relation to extrasystolic and fibrillary contractions. Am J Physiol 1928/1929; 87: 326.

    Google Scholar 

  33. Moe GK, Mendez C, Han J. Aberrant AV impulse propagation in the dog heart: a study of functional bundle branch block. Circ Res 1965; 16: 261.

    Google Scholar 

  34. Allessie MA, Bonke FIM, Schopman FJG. Circus movement in rabbit atrial muscle as a mechanism of tachycardia. III. The ‘leading circle’ concept: a new model of circus movement in cardiac tissue without the involvement of an anatomical obstacle. Circ Res 1977; 41: 9.

    Google Scholar 

  35. El-Sherif N, Smith A, Evans K. Canine ventricular arrhythmias in the late myocardial infarction period: epicardial mapping of reentrant circuits. Circ Res 1981; 49: 255.

    Google Scholar 

  36. El-Sherif N, Mehra R, Gough WB, Zeiler RH. Ventricular activation patterns of spontaneous and induced ventricular rhythms in canine one-day-old myocardial infarction. Evidence for focal and reentrant mechanism. Circ Res 1982; 51: 152.

    Google Scholar 

  37. Wit AL, Allessie MA, Bonke FIM, Lammers W, Smeets J, Fenoglio JJ. Electrophysiological mapping to determine the mechanism of experimental ventricular tachycardia initiated by premature stimulation. Experimental approach and initial results demonstrating reentrant excitation. Am J Cardiol 1982; 49: 166.

    Google Scholar 

  38. Gough WB, Mehra R, Restivo M, Zeiler RH, El-Sherif N. Reentrant ventricular arrhythmia in the late myocardial infarction period in the dog. 13. Correlation of activation and refractory maps. Circ Res 1985; 57: 432.

    Google Scholar 

  39. Restivo M, Gough WB, El-Sherif N. Ventricular arrhythmias in the subacute myocardial infarction period: high resolution activation and refractory patterns of reentrant rhythms. Circ Res 1990; 66: 1310.

    Google Scholar 

  40. Harris L, Downar E, Mickleborough L, Shaikh N, Parson I. Activation sequence of ventricular tachycardia: endocardial and epicardial mapping studies in the human ventricle. J Am Coll Cardiol 1987; 10: 1040.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiology Division, Department of Medicine, State University of New York Health Science Center and the Veterans Administration Medical Center, Brooklyn, New York, USA

    Nabil El-Sherif

Authors
  1. Nabil El-Sherif
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

El-Sherif, N. Electrophysiologic mechanisms of ventricular arrhythmias. Int J Cardiac Imag 7, 141–150 (1991). https://doi.org/10.1007/BF01797747

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01797747

Key words

Search

Navigation