Transmural Dispersion of Repolarization Determines Scroll Wave Behavior During Ventricular Tachyarrhythmias - A Simulation Study
Transmural Dispersion of Repolarization Determines Scroll Wave Behavior During Ventricular Tachyarrhythmias - A Simulation Study
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DOI：
10.1253/circj.cj-10-0071
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发表时间：
2011-01-01
影响因子：
3.3
通讯作者：
Nakazawa, Kazuo
中科院分区：
文献类型：
--
作者：
Haraguchi, Ryo;Ashihara, Takashi;Nakazawa, Kazuo
背景：室性快速性心律失常是心脏性猝死的主要原因，而已知涡卷波折返是这种情况的基础。III类抗心律失常药物在世界范围内常用于治疗室性快速性心律失常;然而，这些药物具有促心律失常的不良反应，可引起尖端扭转型室性心动过速或室颤。心室复极离散度（TDR）已被认为是室性快速心律失常诱导的一个强有力的指标。然而，TDR在持续涡卷波再入过程中的作用知之甚少。本研究的目的是探讨TDR如何影响滚动波的行为，并提供一个新的分析机制，维持快速性心律失常，使用计算机simulation.Methods和结果：计算机模拟进行了量化的TDR和QT间期下的各种I-Ks和I-Kr在跨壁传导。在心室壁平板模型中模拟不同I-Ks和I-Kr下的涡卷波折返，分析涡卷波的行为和细丝动力学（三维组织中心）。TDR的轻微增加，但不是在QT间期，反映了抗心律失常的性能，从限制的滚动波分裂，而TDR的显着增加是programmic，作为结果的滚动波breakth.Conclusions：TDR确定的维持室性快速性心律失常，通过控制的滚动波丝动力学。(Circ J 2011; 75：80-88）
Background: Ventricular tachyarrhythmia is the leading cause of sudden cardiac death, and scroll wave re-entry is known to underlie this condition. Class Ill antiarrhythmic drugs are commonly used worldwide to treat ventricular tachyarrhythmias; however, these drugs have a proarrhythmic adverse effect and can cause Torsade de Pointes or ventricular fibrillation. Transmural dispersion of repolarization (TDR) has been suggested to be a strong indicator of ventricular tachyarrhythmia induction. However, the role of TDR during sustained scroll wave re-entry is poorly understood. The purpose of the present study was to investigate how TDR affects scroll wave behavior and to provide a novel analysis of the mechanisms that sustain tachyarrhythmias, using computer simulations.Methods and Results: Computer simulations were carried out to quantify the TDR and QT interval under a variety of I-Ks and I-Kr during transmural conduction. Simulated scroll wave re-entries were done under a variety of I-Ks and I-Kr in a ventricular wall slab model, and the scroll wave behavior and the filament dynamics (3-dimensional organizing center) were analyzed. A slight increase in TDR, but not in the QT interval, reflected antiarrhythmic properties resulting from the restraint of scroll wave breakup, whereas a marked increase in TDR was proarrhythmic, as a result of scroll wave breakup.Conclusions: The TDR determines the sustainment of ventricular tachyarrhythmias, through control of the scroll wave filament dynamics. (Circ J 2011; 75: 80-88)