Endocardial Activation Drives Activation Patterns During Long-Duration Ventricular Fibrillation and Defibrillation.
Endocardial Activation Drives Activation Patterns During Long-Duration Ventricular Fibrillation and Defibrillation.
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DOI：
10.1161/circep.117.005562
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发表时间：
2017-12
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影响因子：
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通讯作者：
Dosdall DJ
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文献类型：
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作者：
Panitchob N;Li L;Huang J;Ranjan R;Ideker RE;Dosdall DJ
了解驱动室颤的机制对于开发改进的除颤技术以终止室颤(VF)至关重要。在持续超过1-2分钟的室颤(长持续VF，LDVF)中，先前表现出不同的混乱、规则和同步活动的组织模式。我们假设心内膜上的活动可能驱动了LDVF中的这些激活模式，而不成功的除颤电击可能会改变激活模式。在6只犬的左心室心内膜采用电极篮导管和54根6电极插针进行研究。电刺激诱发VF，在短时VF(10 S)和LDVF(7min)后，每10个S给予一次强度递增的电击，直至终止VF。心内膜的激活模式分为混沌(不同的周期长度和不同步的激活)、规则(高度可重复的周期长度)和同步(在激活之间具有舒张期的心内膜快速扩散的激活)。结果表明，VF早期以混沌模式为主，但随着VF的发展呈现出一定的规律性。同步模式仅在VF后期偶有出现。失败的除颤电击改变了LDVF中混沌和规则的激活模式，使其同步，但在SDVF中不同步。这种规则和同步的激活模式是由心内膜表面的快速激活驱动的，这种激活通过跨壁阻断和破裂，导致随着LDVF的进展，心内膜到心外膜的激活率梯度。
Understanding the mechanisms that drive ventricular fibrillation is essential for developing improved defibrillation techniques to terminate ventricular fibrillation (VF). Distinct organization patterns of chaotic, regular, and synchronized activity were previously demonstrated in VF that persisted over 1-2 minutes (long duration VF, LDVF). We hypothesized that activity on the endocardium may be driving these activation patterns in LDVF and that unsuccessful defibrillation shocks may alter activation patterns. The study was performed using a 64-electrode basket catheter on the left ventricle endocardium and 54 6-electrode plunge needles inserted into the left ventricles of 6 dogs. VF was induced electrically and following short duration VF (SDVF, 10 s) and LDVF (7 minutes), shocks of increasing strengths were delivered every 10 s until VF was terminated. Endocardial activation patterns were classified as chaotic (varying cycle lengths and nonsynchronous activations), regular (highly repeatable cycle lengths), and synchronized (activation that spreads rapidly over the endocardium with diastolic periods between activations). The results showed that the chaotic pattern was predominant in early VF, but the regular pattern emerges as VF progressed. The synchronized pattern only emerged occasionally during late VF. Failed defibrillation shocks changed chaotic and regular activation patterns to synchronized in LDVF, but not in SDVF. The regular and synchronized patterns of activation were driven by rapid activations on the endocardial surface that blocked and broke up transmurally, leading to an endocardial to epicardial activation rate gradient as LDVF progressed.