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Amoni M, Claus P, Dries E, et al. Discrete sites of frequent premature ventricular complexes cluster within the infarct border zone and coincide with high frequency of delayed afterdepolarizations under adrenergic stimulation. Heart Rhythm. 2021;18(11):1976-1987doi: 10.1016/j.hrthm.2021.07.067.
Amoni, M., Claus, P., Dries, E., Nagaraju, C., De Buck, S., Vandenberk, B., Ingelaere, S., Vermoortele, D., Roderick, H. L., Sipido, K. R., & Willems, R. (2021). Discrete sites of frequent premature ventricular complexes cluster within the infarct border zone and coincide with high frequency of delayed afterdepolarizations under adrenergic stimulation. Heart rhythm, 18(11), 1976-1987. https://doi.org/10.1016/j.hrthm.2021.07.067
Amoni, Matthew, et al. "Discrete sites of frequent premature ventricular complexes cluster within the infarct border zone and coincide with high frequency of delayed afterdepolarizations under adrenergic stimulation." Heart rhythm vol. 18,11 (2021): 1976-1987. doi: https://doi.org/10.1016/j.hrthm.2021.07.067
Amoni M, Claus P, Dries E, Nagaraju C, De Buck S, Vandenberk B, Ingelaere S, Vermoortele D, Roderick HL, Sipido KR, Willems R. Discrete sites of frequent premature ventricular complexes cluster within the infarct border zone and coincide with high frequency of delayed afterdepolarizations under adrenergic stimulation. Heart Rhythm. 2021 Nov;18(11):1976-1987. doi: 10.1016/j.hrthm.2021.07.067. Epub 2021 Aug 08. PMID: 34371193.
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Heart Rhythm. 2021 Nov;18(11):1976-1987. doi: 10.1016/j.hrthm.2021.07.067. Epub 2021 Aug 08.

Discrete sites of frequent premature ventricular complexes cluster within the infarct border zone and coincide with high frequency of delayed afterdepolarizations under adrenergic stimulation.

Heart rhythm

Matthew Amoni, Piet Claus, Eef Dries, Chandan Nagaraju, Stijn De Buck, Bert Vandenberk, Sebastian Ingelaere, Dylan Vermoortele, H Llewelyn Roderick, Karin R Sipido, Rik Willems

Affiliations

  1. Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Division of Cardiology, University Hospitals Leuven, Leuven, Belgium.
  2. Imaging and Cardiovascular Dynamics, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
  3. Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
  4. Processing Speech and Images, Department of Electrical Engineering, KU Leuven, Leuven, Belgium.
  5. Division of Cardiology, University Hospitals Leuven, Leuven, Belgium.
  6. Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium. Electronic address: [email protected].
  7. Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Division of Cardiology, University Hospitals Leuven, Leuven, Belgium. Electronic address: [email protected].

PMID: 34371193 DOI: 10.1016/j.hrthm.2021.07.067

Abstract

BACKGROUND: Sympathetic activation in ischemic heart disease can cause lethal arrhythmias. These often are preceded by premature ventricular complexes (PVCs), which at the cellular level could result from delayed afterdepolarizations.

OBJECTIVE: The purpose of this study was to identify and map vulnerable areas for arrhythmia initiation after myocardial infarction (MI) and to explore the link between PVCs and cellular events.

METHODS: Anterior-septal wall MI was induced by 120 minutes of coronary occlusion followed by reperfusion (27 MI and 16 sham pigs). After 4 weeks, EnSite™ electroanatomic mapping combined with imaging was performed to precisely locate PVC sites of origin and subsequently record monophasic action potentials. Cardiomyocytes were isolated from different regions to study regional cellular remodeling. Isoproterenol was used as a surrogate for adrenergic stimulation both in vivo and in cardiomyocytes.

RESULTS: PVCs originated from the MI border zone (BZ) and occurred at discrete areas with clusters of PVCs within the BZ. At these sites, frequent delayed afterdepolarizations and occasional associated spontaneous action potentials translating to a PVC were present. Cardiomyocytes isolated from the MI BZ exhibited more spontaneous action potentials than cardiomyocytes from remote regions. Sensitivity to adrenergic stimulation was increased in MI, in vivo and in cardiomyocytes. In awake, freely moving MI animals, frequent PVCs, ventricular arrhythmia, and sudden cardiac death occurred spontaneously at moderately elevated heart rates.

CONCLUSION: Post-MI, arrhythmias initiate from discrete vulnerable areas within the BZ, where delayed afterdepolarizations, related to increased adrenergic response of BZ cardiomyocytes, can generate PVCs.

Copyright © 2021 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Keywords: Action potential; Delayed afterdepolarization; Myocardial infarction; Noncontact electroanatomic mapping; Premature ventricular complex

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