Mechanism of Ventricular Fibrillation : Establishment of Novel Technique for Predicting Sudden Cardiac Death

心源性猝死（SCD）仍然是当代心脏病学的主要挑战之一。主要的临床试验表明，植入式心律转复除颤器（ICD）的初级预防在挽救生命方面是有效的。众所周知，SCD主要由心室颤动（VF）引起。在这项研究中，我们试图阐明VF的机制，并建立预测SCD的技术。在第一年（2009年），我们利用超级计算机和动物模型的制图分析，通过计算机模拟评估了与VF产生相关的电生理指标。因此，VF的产生与复极化异常的关系大于与去极化异常的关系。在第二年（2010年），我们重新分析了第一年获得的数据，然后评估了哪些电生理标志物有助于检测复极异常。T波交替（TWA），即心电图上T波的交替，似乎是检测异常的最佳标志。去年，我们评估了TWA和其他电生理指标的临床应用，如在某些情况下（心肌梗死、心肌病等）的信号平均心电图和心率波动的晚电位。我们的数据支持TWA是检测有SCD风险患者最有用的技术。

Sudden cardiac death(SCD) remains one of the major challenges of contemporary cardiology. Major clinical trials have demonstrated that primary prophylaxis of implantable cardioverter-defibrillators(ICD) is effective in saving lives. It is well known that SCD is caused by mainly ventricular fibrillation(VF). In this study, we seek to clarify the mechanism of VF and to establish techniques for predicting SCD. At the first year(2009), we assessed electrophysiological indices that are related to the generation of VF with computer simulation using super computer and mapping analysis from animal models. As a result, the generation of VF is more associated with repolarization abnormality than depolarization abnormality. At the second year(2010), we reanalyzed data that obtained at the first year, then, assessed which electrophysiological marker is useful to detect repolarization abnormality. T-wave alternans(TWA), i. e., alternation of T wave on the electrocardiogram appears to be the best marker to detect the abnormality. At the last year, we evaluated clinical utility of TWA and other electrophysiological makers such as late potentials by signal-averaged electrocardiography and heart rate turbulence in some settings(myocardial infarction, cardiomyopathy, etc). Our data support that TWA is the most useful technique to detect patients at risk for SCD.