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Downar E, Janse MJ, Bhaskaran A, et al. High density intramural mapping of post-infarct premature ventricular contractions and ventricular tachycardia. Pacing Clin Electrophysiol. 2021;44(10):1781-1785doi: 10.1111/pace.14326.
Downar, E., Janse, M. J., Bhaskaran, A., Niri, A., Velluppillai, A., Massé, S., & Nanthakumar, K. (2021). High density intramural mapping of post-infarct premature ventricular contractions and ventricular tachycardia. Pacing and clinical electrophysiology : PACE, 44(10), 1781-1785. https://doi.org/10.1111/pace.14326
Downar, Eugene, et al. "High density intramural mapping of post-infarct premature ventricular contractions and ventricular tachycardia." Pacing and clinical electrophysiology : PACE vol. 44,10 (2021): 1781-1785. doi: https://doi.org/10.1111/pace.14326
Downar E, Janse MJ, Bhaskaran A, Niri A, Velluppillai A, Massé S, Nanthakumar K. High density intramural mapping of post-infarct premature ventricular contractions and ventricular tachycardia. Pacing Clin Electrophysiol. 2021 Oct;44(10):1781-1785. doi: 10.1111/pace.14326. Epub 2021 Aug 26. PMID: 34314041.
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Pacing Clin Electrophysiol. 2021 Oct;44(10):1781-1785. doi: 10.1111/pace.14326. Epub 2021 Aug 26.

High density intramural mapping of post-infarct premature ventricular contractions and ventricular tachycardia.

Pacing and clinical electrophysiology : PACE

Eugene Downar, Michiel J Janse, Abhishek Bhaskaran, Ahmed Niri, Arulalan Velluppillai, Stéphane Massé, Kumaraswamy Nanthakumar

Affiliations

  1. Division of Cardiology. Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
  2. Experimental and Molecular Cardiology Group, Academic Medical Center, Amsterdam, Netherlands.

PMID: 34314041 DOI: 10.1111/pace.14326

Abstract

BACKGROUND: Spontaneous ventricular premature contractions (PVCs) and ventricular tachycardia (VT) in the acute post infarct milieu is assumed to be due to automaticity. However, the mechanism has not been studied with intramural mapping.

OBJECTIVE: To study the mechanism of spontaneous PVCs with high density intramural mapping in a canine model, and to test the hypothesis that post-infarct PVCs and VT are due to re-entry rather than automaticity.

METHODS: In 15 anesthetized dogs, using 768 intramural unipolar electrograms, simultaneous recordings were made. After 20 min of stabilization, recordings were made during the first 10 min of ischemia, and activation maps of individual beats were constructed. Acute ischemia was produced by clamping the left anterior descending coronary artery proximal to the first diagonal branch.

RESULTS: In all experiments ST-T alternans was present. Spontaneous ventricular beats occurred in five of 15 dogs where the earliest ectopic activity was manifested in the endocardium, well within the ischemic zone. From there, activity spread rapidly along the subendocardium, with endo-to epicardial spread along the non-ischemic myocardium. Epicardial breakthrough always occurred at the border of the ischemic myocardium. In three dogs, delayed potentials were observed, which were earliest at the ischemic epicardium and extended transmurally with increasing delay towards the endocardium, where they culminated in a premature beat. A similar sequence was observed in VT that followed.

CONCLUSION: Graded responses that occur with each sinus beat intramurally, when able to propagate from epicardium to endocardium are the mechanism of PVCs and VT in post-infarct myocardium.

© 2021 The Authors. Pacing and Clinical Electrophysiology published by Wiley Periodicals LLC.

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