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Electrophysiologic Precursors of Ventricular Tachyarrhythmias

Electrophysiologic Precursors of Ventricular Tachyarrhythmias Abstract The immediate cause of cardiac sudden death in the majority of cases, is ventricular fibrillation (VF); VF is precipitated by ventricular premature beats (VPBs) which are early enough to interrupt the T wave. The basis for ventricular vulnerability is inhomogeneous excitability of the ventricle in its relative refractoriness. The premature impulse initiated during the vulnerable period is forced to propagate along irregular wave fronts and this will predispose the ventricle to multiple reentrant activity and subsequent fractionation of the wave fronts into many irregular wavelets. Ventricular fibrillation is more likely to be induced by early VPBs in the presence of clinical and electrocardiographic evidence of myocardial infarction, long ventricular cycle lengths, Q-T prolongation, and increase in the T wave amplitude. These changes are associated with increased inhomogeneity of excitability in ventricular myocardium. References 1. Lovell RRH, Prineas RJ: Mechanisms of sudden death and their implications for prevention and management. Prog Cardiovasc Dis 13:482-494, 1971.Crossref 2. Lown B, Klein MD, Hershberg PI: Coronary and precoronary care. Amer J Med 46:705-724,1969.Crossref 3. Lown B, Wolf M: Approaches to sudden death from coronary heart disease. Circulation 44:130-142, 1971.Crossref 4. Han J: Mechanisms of ventricular arrhythmias associated with myocardial infarction. Amer J Cardiol 24:800-813, 1969.Crossref 5. Han J: Ventricular vulnerability during coronary occlusion. Amer J Cardiol 24:857-864, 1969.Crossref 6. Hiss RG, Lamb LE: Elecrocardiographic findings in 122,043 individuals. Circulation 25:947-961, 1962.Crossref 7. Pell S, D'Alonzo CA: Three year study of myocardial infarction in a large employed population. JAMA 173:463-470, 1961.Crossref 8. Chiang BN, Perlman LV, Ostrander LD, et al: Relationship of premature systoles to coronary heart disease and sudden death in the Tecumseh epidemiologic study. Ann Intern Med 70:1159-1166, 1969.Crossref 9. Shanoff HM, Little JA: Studies of male survivors of myocardial infarction: VIII. The electrocardiogram and ten year survival. Amer J Cardiol 18:535-539, 1966.Crossref 10. Wiggers CJ: The mechanism and nature of ventricular fibrillation. Amer Heart J 20:399-414, 1940.Crossref 11. Moe GK, Harris AS, Wiggers CJ: Analysis of initiation of fibrillation by electrographic studies. Amer J Physiol 134:473-492, 1941. 12. Moe GK, Abildskov JA, Han J: Factors responsible for initiation and maintenance of ventricular fibrillation , in Surawicz B, Pellegrino ED (eds): Sudden Cardiac Death . New York, Grune & Stratton Inc, 1964, p 56-63. 13. Han J, Garcia de Jalon P, Moe GK: Adrenergic effects on ventricular vulnerability. Circ Res 14:516-524, 1964.Crossref 14. Han J, Garcia de Jalon P, Moe GK: Fibrillation threshold of premature ventricular responses. Circ Res 18:18-25, 1966.Crossref 15. Han J, Moe GK: Nonuniform recovery of excitability in ventricular muscle. Cir Res 14:44-60, 1964.Crossref 16. Han J, Goel BG, Hanson CS: Re-entrant beats induced in the ventricle during coronary occlusion. Amer Heart J 80:778-784, 1970.Crossref 17. Han J: The concepts of re-entrant activity responsible for ectopic rhythms. Amer J Cardiol 28:253-262, 1971.Crossref 18. James TN: Congenital deafness and cardiac arrhythmias. Amer J Cardiol 19:627-643, 1967.Crossref 19. James TN: QT prolongation and sudden death. Mod Conc Cardiovasc Dis 38:35-37, 1969. 20. Han J, Millet D, Chizzonitti B, et al: Temporal dispersion of recovery of excitability in atrium and ventricle as a function of heart rate. Amer Heart J 71:481-487, 1966.Crossref 21. Han J, DeTraglia J, Millet D, et al: Incidence of ectopic beats as a function of basic rate in the ventricle. Amer Heart J 72:632-639, 1966.Crossref 22. Lasser RP, Haft JI, Friedberg CK: Relationship of right bundle branch block and marked left axis deviation to complete heart block and syncope. Circulation 37:429-437, 1968.Crossref 23. Lopez JF: Electrocardiographic findings in patients with complete atrioventricular block. Brit Heart J 30:20-28, 1968.Crossref 24. Binder MJ, Rosove L: Paroxysmal ventricular tachycardia and fibrillation due to quinidine. Amer J Med 12:491-497, 1952.Crossref 25. Schoonmaker FW, Osteen RT, Greenfield JC: Thioridazine (Mellaril)-induced ventricular tachycardia controlled with an artificial pacemaker. Ann Intern Med 65:1076-1078, 1966.Crossref 26. Mandel WJ, Burgess MJ, Neville J, et al: Analysis of T-wave abnormalities associated with myocardial infarction using a theoretic model. Circulation 38:178-188, 1968.Crossref 27. Harris AS, Estandia A, Tillatson RF: Ventricular ectopic rhythms and ventricular fibrillation following cardiac sympathectomy and coronary occlusion. Amer J Physiol 165:505-512, 1951. 28. Abildskov JA, Miller K, Burgess MJ, et al: The electrocardiogram and the central nervous system. Prog Cardiovasc Dis 13:210-216, 1970.Crossref 29. Melville KI, Blum B, Shister HE, et al: Cardiac ischemic changes and arrhythmias induced by hypothalamic stimulation. Amer J Cardiol 12:781-791, 1963.Crossref 30. Yanowitz F, Preston JB, Abildskov JA: Functional distribution of right and left stellate innervation to the ventricles: Production of neurogenic electrocardiographic changes by unilateral alteration of sympathetic tone. Circ Res 18:416-428, 1966.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Electrophysiologic Precursors of Ventricular Tachyarrhythmias

Archives of Internal Medicine , Volume 129 (5) – May 1, 1972

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American Medical Association
Copyright
Copyright © 1972 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1972.00320050073007
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Abstract

Abstract The immediate cause of cardiac sudden death in the majority of cases, is ventricular fibrillation (VF); VF is precipitated by ventricular premature beats (VPBs) which are early enough to interrupt the T wave. The basis for ventricular vulnerability is inhomogeneous excitability of the ventricle in its relative refractoriness. The premature impulse initiated during the vulnerable period is forced to propagate along irregular wave fronts and this will predispose the ventricle to multiple reentrant activity and subsequent fractionation of the wave fronts into many irregular wavelets. Ventricular fibrillation is more likely to be induced by early VPBs in the presence of clinical and electrocardiographic evidence of myocardial infarction, long ventricular cycle lengths, Q-T prolongation, and increase in the T wave amplitude. These changes are associated with increased inhomogeneity of excitability in ventricular myocardium. References 1. Lovell RRH, Prineas RJ: Mechanisms of sudden death and their implications for prevention and management. Prog Cardiovasc Dis 13:482-494, 1971.Crossref 2. Lown B, Klein MD, Hershberg PI: Coronary and precoronary care. Amer J Med 46:705-724,1969.Crossref 3. Lown B, Wolf M: Approaches to sudden death from coronary heart disease. Circulation 44:130-142, 1971.Crossref 4. Han J: Mechanisms of ventricular arrhythmias associated with myocardial infarction. Amer J Cardiol 24:800-813, 1969.Crossref 5. Han J: Ventricular vulnerability during coronary occlusion. Amer J Cardiol 24:857-864, 1969.Crossref 6. Hiss RG, Lamb LE: Elecrocardiographic findings in 122,043 individuals. Circulation 25:947-961, 1962.Crossref 7. Pell S, D'Alonzo CA: Three year study of myocardial infarction in a large employed population. JAMA 173:463-470, 1961.Crossref 8. Chiang BN, Perlman LV, Ostrander LD, et al: Relationship of premature systoles to coronary heart disease and sudden death in the Tecumseh epidemiologic study. Ann Intern Med 70:1159-1166, 1969.Crossref 9. Shanoff HM, Little JA: Studies of male survivors of myocardial infarction: VIII. The electrocardiogram and ten year survival. Amer J Cardiol 18:535-539, 1966.Crossref 10. Wiggers CJ: The mechanism and nature of ventricular fibrillation. Amer Heart J 20:399-414, 1940.Crossref 11. Moe GK, Harris AS, Wiggers CJ: Analysis of initiation of fibrillation by electrographic studies. Amer J Physiol 134:473-492, 1941. 12. Moe GK, Abildskov JA, Han J: Factors responsible for initiation and maintenance of ventricular fibrillation , in Surawicz B, Pellegrino ED (eds): Sudden Cardiac Death . New York, Grune & Stratton Inc, 1964, p 56-63. 13. Han J, Garcia de Jalon P, Moe GK: Adrenergic effects on ventricular vulnerability. Circ Res 14:516-524, 1964.Crossref 14. Han J, Garcia de Jalon P, Moe GK: Fibrillation threshold of premature ventricular responses. Circ Res 18:18-25, 1966.Crossref 15. Han J, Moe GK: Nonuniform recovery of excitability in ventricular muscle. Cir Res 14:44-60, 1964.Crossref 16. Han J, Goel BG, Hanson CS: Re-entrant beats induced in the ventricle during coronary occlusion. Amer Heart J 80:778-784, 1970.Crossref 17. Han J: The concepts of re-entrant activity responsible for ectopic rhythms. Amer J Cardiol 28:253-262, 1971.Crossref 18. James TN: Congenital deafness and cardiac arrhythmias. Amer J Cardiol 19:627-643, 1967.Crossref 19. James TN: QT prolongation and sudden death. Mod Conc Cardiovasc Dis 38:35-37, 1969. 20. Han J, Millet D, Chizzonitti B, et al: Temporal dispersion of recovery of excitability in atrium and ventricle as a function of heart rate. Amer Heart J 71:481-487, 1966.Crossref 21. Han J, DeTraglia J, Millet D, et al: Incidence of ectopic beats as a function of basic rate in the ventricle. Amer Heart J 72:632-639, 1966.Crossref 22. Lasser RP, Haft JI, Friedberg CK: Relationship of right bundle branch block and marked left axis deviation to complete heart block and syncope. Circulation 37:429-437, 1968.Crossref 23. Lopez JF: Electrocardiographic findings in patients with complete atrioventricular block. Brit Heart J 30:20-28, 1968.Crossref 24. Binder MJ, Rosove L: Paroxysmal ventricular tachycardia and fibrillation due to quinidine. Amer J Med 12:491-497, 1952.Crossref 25. Schoonmaker FW, Osteen RT, Greenfield JC: Thioridazine (Mellaril)-induced ventricular tachycardia controlled with an artificial pacemaker. Ann Intern Med 65:1076-1078, 1966.Crossref 26. Mandel WJ, Burgess MJ, Neville J, et al: Analysis of T-wave abnormalities associated with myocardial infarction using a theoretic model. Circulation 38:178-188, 1968.Crossref 27. Harris AS, Estandia A, Tillatson RF: Ventricular ectopic rhythms and ventricular fibrillation following cardiac sympathectomy and coronary occlusion. Amer J Physiol 165:505-512, 1951. 28. Abildskov JA, Miller K, Burgess MJ, et al: The electrocardiogram and the central nervous system. Prog Cardiovasc Dis 13:210-216, 1970.Crossref 29. Melville KI, Blum B, Shister HE, et al: Cardiac ischemic changes and arrhythmias induced by hypothalamic stimulation. Amer J Cardiol 12:781-791, 1963.Crossref 30. Yanowitz F, Preston JB, Abildskov JA: Functional distribution of right and left stellate innervation to the ventricles: Production of neurogenic electrocardiographic changes by unilateral alteration of sympathetic tone. Circ Res 18:416-428, 1966.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: May 1, 1972

References