NONSTATIONARY VORTEX-LIKE REENTRANT ACTIVITY AS A MECHANISM OF POLYMORPHIC VENTRICULAR-TACHYCARDIA IN THE ISOLATED RABBIT HEART
NONSTATIONARY VORTEX-LIKE REENTRANT ACTIVITY AS A MECHANISM OF POLYMORPHIC VENTRICULAR-TACHYCARDIA IN THE ISOLATED RABBIT HEART
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DOI：
10.1161/01.cir.91.9.2454
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发表时间：
1995-05-01
期刊：
影响因子：
37.8
通讯作者：
PERTSOV, AM
中科院分区：
文献类型：
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作者：
GRAY, RA;JALIFE, J;PERTSOV, AM
背景室性心动过速可由心肌的旋涡样折返性兴奋引起。我们的一般假设是，在结构正常的心脏，这些心律失常的结果是一个或两个非平稳的三维电涡卷波激活的心脏muscle在非常高的frequency.Methods和结果我们使用了高分辨率的视频成像，心电图，图像处理的组合在离体兔心脏，连同数学建模。我们的特点是动态变化的跨膜电位模式的心外膜表面的心室使用光学标测。图像处理技术被用来识别表面表现的折返组织中心，这些中心的位置被用来确定折返路径的运动。我们还使用数值模拟结合Fitzhugh-Nagumo动力学和现实的心脏几何形状，研究如何固定和非固定的涡卷波表现在心外膜表面和模拟的EGG。我们提出的心外膜表面表现（折返螺旋波）和心电图模式的非稳态折返活动是一致的，在右心室和左心室建立的涡卷波所产生的。我们确定了多形性心动过速时心外膜表面折返回路的组织中心，这些中心在发作过程中发生了移动。此外，显示折返中心最大运动的心律失常显示QRS形态变化最大。数值模拟结果表明，稳态涡卷波引起单形ECG信号，而非稳态蜿蜒涡卷波引起尖端扭转型室性心动过速的波形特征。结论健康离体兔心脏的多形性室性心动过速是单形或成对的结果（“8字形”）非静止涡卷波，涡卷波运动的程度对应于EGG中多态性的程度。这些结果是一致的，我们的数值模拟，显示单态心电图活动模式的固定涡卷波，但多形态模式的涡卷波是不稳定的。
Background Ventricular tachycardia may result from vortexlike reentrant excitation of the myocardium. Our general hypothesis is that in the structurally normal heart, these arrhythmias are the result of one or two nonstationary three-dimensional electrical scroll waves activating the heart muscle at very high frequencies.Methods and Results We used a combination of high-resolution video imaging, electrocardiography, and image processing in the isolated rabbit heart, together with mathematical modeling. We characterized the dynamics of changes in transmembrane potential patterns on the epicardial surface of the ventricles using optical mapping. Image processing techniques were used to identify the surface manifestation of the reentrant organizing centers, and the location of these centers was used to determine the movement of the reentrant pathway. We also used numerical simulations incorporating Fitzhugh-Nagumo kinetics and realistic heart geometry to study how stationary and nonstationary scroll waves are manifest on the epicardial surface and in the simulated EGG. We present epicardial surface manifestations (reentrant spiral waves) and ECG patterns of nonstationary reentrant activity that are consistent with those generated by scroll waves established at the right and left ventricles. We identified the organizing centers of the reentrant circuits on the epicardial surface during polymorphic tachycardia, and these centers moved during the episodes. In addition, the arrhythmias that showed the greatest movement of the reentrant centers displayed the largest changes in QRS morphology. The numerical simulations showed that stationary scroll waves give rise to monomorphic ECG signals, but nonstationary meandering scroll waves give rise to undulating ECGs characteristic of torsade de pointes.Conclusions Polymorphic ventricular tachycardia in the healthy, isolated rabbit heart is the result of either a single or paired (''figure-of-eight'') nonstationary scroll waves, The extent of the scroll wave movement corresponds to the degree of polymorphism in the EGG. These results are consistent with our numerical simulations that showed monomorphic ECG patterns of activity for stationary scroll waves but polymorphic patterns for scroll waves that were nonstationary.