Characteristics of wave fronts during ventricular fibrillation in human hearts with dilated cardiomyopathy: Role of increased fibrosis in the generation of reentry
Characteristics of wave fronts during ventricular fibrillation in human hearts with dilated cardiomyopathy: Role of increased fibrosis in the generation of reentry
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DOI：
10.1016/s0735-1097(98)00184-3
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发表时间：
1998-07-01
影响因子：
24
通讯作者：
Chen, PS
中科院分区：
文献类型：
--
作者：
Wu, TJ;Ong, JJC;Chen, PS
目标.本研究旨在评价扩张型心肌病（DCM）患者心室颤动（VF）过程中波前的特征，并确定VF过程中纤维化增加在折返中的作用。在人类VF期间纤维化增加在折返形成中的作用尚不清楚。来自DCM移植受者的五个心脏由Langendorff灌注支持，并在VF期间标测。使用斑块电极阵列vith 477双极电极（1.6 mm分辨率）进行心外膜标测。在5号心脏中，我们也使用了440个透壁双极记录。每个映射区域进行组织学分析。分析了心外膜记录的15次VF（8 s/次），观察到55次折返。折返的寿命很短（1 - 4个周期），平均周期长度为172 +/- 24 ms。在5号心脏中，显示了透壁涡卷波。最常见的折返起始模式是心外膜突破，其次是平行于心外膜纤维方向的传导阻滞线（55次发作中的34次[62%]）。组织学检查显示，在有阻滞线的区域，心外膜肌纤维和肌束沿纤维方向的纵轴沿着分离，纤维化明显。这些区域的平均纤维组织百分比（n = 20）显著高于无阻滞区域（n = 28）（24 +/- 7.5% vs. 10 +/-3.8%，p < 0.0001）。在患有DCM的人类心脏中，在VF期间存在心外膜折返波前和透壁滚动波。增加的纤维化提供了传导阻滞的部位，导致折返的连续产生。
Objectives. We sought to evaluate the characteristics of wave fronts during ventricular fibrillation (VF) in human hearts with dilated cardiomyopathy (DCM) and to determine the role of increased fibrosis in the generation of reentry during VF.Background. The role of increased fibrosis in reentry formation during human VF is unclear.Methods. Five hearts from transplant recipients with DCM were supported by Langendorff perfusion and were mapped during VF. A plaque electrode array,vith 477 bipolar electrodes (1.6-mm resolution) was used for epicardial mapping. In heart no. 5, we also used 440 transmural bipolar recordings. Each mapped area was analyzed histologically.Results. Fifteen runs of VF (8 s/run) recorded from the epicardium were analyzed, and 55 episodes of reentry were observed. The life span of reentry was short (one to four cycles), and the mean cycle length was 172 +/- 24 ms. In heart no. 5, transmural scroll waves were demonstrated. The most common mode of initiation of reentry was epicardial breakthrough, followed by a line of conduction block parallel to the epicardial fiber orientation (34 [62%] of 55 episodes). In the areas with lines of block, histologic examination showed significant fibrosis separating the epicardial muscle fibers and bundles along the longitudinal axis of fiber orientation. The mean percent fibrous tissue in these areas (n = 20) was significantly higher than that in the areas without block (n = 28) (24 +/- 7.5% vs. 10 +/- 3.8%, p < 0.0001).Conclusions. In human hearts with DCM, epicardial reentrant wave fronts and transmural scroll waves were present during VF. Increased fibrosis provides; a site for conduction block, leading to the continuous generation of reentry.