© 1996 American Heart Association, Inc.
Articles |
Reentrant Wave Fronts in Wiggers' Stage II Ventricular Fibrillation
Characteristics and Mechanisms of Termination and Spontaneous Regeneration
From the Division of Cardiology, Department of Medicine (J.J.L., K.K., D.H., C.H., W.F., C.B., T.I., H.S.K., P.-S.C.), and the Department of Pathology (M.C.F.), Cedars-Sinai Medical Center and UCLA School of Medicine, Los Angeles, Calif.
Correspondence to John J. Lee, MD, Division of Cardiology, Room 5314, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048.
Abstract The mechanisms of Wiggers' stage II
ventricular fibrillation (VF) are poorly understood. Using
computerized mapping techniques, we studied the patterns of activation
during Wiggers' stage II VF in 13 open-chest dogs. In 7 of the 13
dogs, the right ventricular Purkinje fibers and adjacent
subendocardial myocytes were ablated with Lugol solution. VF was
induced electrically, and 3 to 5 seconds of data were obtained
beginning 
2.5 seconds after the onset of VF. Dynamic displays of the
activation patterns and isochronal maps revealed the presence of
reentrant wave fronts in 17 of 33 runs of VF in ablated ventricles and
in 12 of 45 runs of VF in intact ventricles. The incidence of reentry
was not different between the subendocardium-ablated group versus
the nonablated group (1.7±1.6 versus 1.2±1.6 rotations per
episode of
VF, P=.19). There were no differences in the core size
(25±19 versus 29±18 mm2), life span (3.4±1.1
versus
3.2±1.2 rotations), or cycle length (111±12 versus 107±8
ms) in
ablated ventricles versus intact ventricles, respectively. The core was
unstable as it meandered within the mapped area displacing the entire
reentrant wave front. In all episodes, the reentrant wave fronts were
spontaneously initiated by an interaction between two propagating wave
fronts roughly perpendicular to each other. The second wave front met
the tail of the first wave front 69±11 ms (range, 40 to 90 ms) after
its latest activation, indicating that the interaction occurred during
a vulnerable period. The reentrant wave fronts terminated spontaneously
(n=7), as the result of interference by an invading wave front
(n=19),
or meandered off the mapped region (n=3). We conclude the following:
(1) Reentrant activities with short life spans and meandering cores are
present during Wiggers' stage II VF in dogs. (2) New reentrant
wave fronts are generated when one wave front interacts with another
wave front during its vulnerable period. (3) The reentrant wave fronts
terminate spontaneously or as the result of interference. (4) Chemical
subendocardial ablation does not affect the incidence, life span, cycle
length, or core size of the reentrant wave fronts.
Key Words: Purkinje fibers • vulnerable period • core • spiral wave • sudden cardiac death
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