© 1995 American Heart Association, Inc.
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Interaction Between Strong Electrical Stimulation and Reentrant Wavefronts in Canine Ventricular Fibrillation
From the Division of Cardiology, Department of Medicine, and Department of Pathology, Cedars-Sinai Medical Center, and UCLA School of Medicine, Los Angeles, Calif.
Abstract This study was designed to test the hypothesis that
the effects of a strong electrical stimulus on reentrant wavefronts in
ventricular fibrillation (VF) are dependent on the timing
of the stimulus. We studied six open-chest dogs by computerized mapping
techniques. A plaque electrode array with up to 509 bipolar electrodes
was placed on the right ventricular epicardium. The
interelectrode distance was 1.6 mm, and the interpolar distance was 0.5
mm. After eight baseline pacing stimuli (S1) with cycle
lengths of 300 ms, a strong premature stimulus (S2) (73±10
mA) was given to induce VF. In subsequent episodes, a second strong
premature stimulus (S3) was given at progressively longer
S2-S3 intervals in 20-ms increments. The
results showed that, at baseline, the S2
consistently induced figure-eight reentry and VF. The VF cycle
length immediately after the S2 averaged 108±17 ms. The
S3 resulted in one of the following responses: (1)
termination of reentry and VF; (2) induction of different reentrant
wavefronts or a focal pattern of repetitive activation; or (3)
persistence of the same figure-eight reentry. The intervals between the
S3 and the immediately preceding activation at the site of
the S3 (the recovery intervals) were 39±12 ms (range, 20
to 60 ms) and 61±20 ms (range, 30 to 90 ms) for response patterns 1
and 2, respectively. The recovery intervals associated with response
pattern 3 were either 
30 ms (22±8 ms) or 
80 ms (94±15 ms). The
differences among these four intervals were significant
(P<.001). We conclude that the effects of strong electrical
stimulation on the reentrant wavefronts in VF are dependent on the
recovery interval since the previous local activation. A protective
zone occurred between 20 and 60 ms, during which time a strong
electrical stimulus could terminate reentry and abort VF. This zone was
followed by a vulnerable period during which new activation wavefronts
could be induced. If a strong electrical stimulus was given shortly
after or sufficiently long after the previous local activation, the
same figure-eight reentrant pattern continued.
Key Words: vulnerability • defibrillation • sudden cardiac death • electrophysiology • protective zone
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