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Pathophysiology of Ventricular Tachycardia in Man

Pathophysiology of Ventricular Tachycardia in Man Abstract Understanding the pathophysiologic mechanisms leading to ventricular arrhythmias seems indispensable for rational treatment. However, a detailed study of these mechanisms in the intact human heart is not possible at present. Therefore, we have to transpose knowledge obtained from observations on single cells, isolated muscle strips, and animal hearts to the human heart, with the inherent danger of making incorrect extrapolations. The recent introduction of programmed electrical stimulation of the heart gives us the opportunity to bridge a part of the gap by studying some aspects of the mechanisms of arrhythmias directly in the human heart. The purpose of this article is to review the possibilities and limitations of this technique to study ventricular tachycardia in man. As recently reviewed by Scherf and Schott,1 Bigger,2 and Watanabe and Dreifus,3 cardiac arrhythmias can result from different electrophysiologic mechanisms. These mechanisms can be classified as (1) abnormalities in impulse formation, References 1. Scherf D, Schott A: Extrasystoles and Allied Arrhythmias , ed 2. London, William Heinemann, 1973. 2. Bigger JT: Electrical properties of cardia muscle and possible causes of cardiac arrhythmias , in Dreifus LS, Likoff W (eds): Cardiac Arrhythmias . New York, Grune & Stratton, 1973, pp 13-34. 3. Watanabe Y, Dreifus LS: Arrhythmias: Mechanisms and pathogenesis , in Dreifus LS, Likoff W (eds): Cardiac Arrhythmias . New York, Grune & Stratton, 1973, pp 35-54. 4. Moe GK, Mendez C: The physiologic basis of reciprocal rhythms. Prog Cardiovasc Dis 8:461-482, 1966.Crossref 5. Durrer D, Roos JP: Epicardial excitation of the ventricles in a patient with W.P.W. syndrome. Circulation 35:15-21, 1967.Crossref 6. Durrer D, et al: The role of premature beats in the initiation and termination of supraventricular tachycardia in the Wolff-Parkinson-White syndrome. Circulation 36:644-662, 1967.Crossref 7. Coumel Ph, et al: Tachycardia permanente par rythme réciproque. Arch Mal Coeur 60:1830-1864, 1967. 8. Goldreyer BN, Bigger JT: Spontaneous and induced re-entrant tachycardia. Ann Intern Med 70:87-98, 1969.Crossref 9. Wellens HJJ: Electrical Stimulation of the Heart in the Study and Treatment of Tachycardias . Baltimore, University Park Press, 1971. 10. Wellens HJ, Schuilenburg RM, Durrer D: Electrical stimulation of the heart in patients with ventricular tachycardia. Circulation 46:216-225, 1972.Crossref 11. Wellens HJ, Lie KI, Durrer D: Further observations on ventricular tachycardia as studied by electrical stimulation of the heart. Circulation 49:647-653, 1974.Crossref 12. Wenckebach KF, Winterberg H: Die unregelmässige Herztätigkeit . Leipzig, Germany, Wilhelm Engelmann, 1927. 13. Sasyniuk BJ, Mendez C: A mechanism for re-entry in canine ventricular tissue. Circ Res 28:3-15, 1971.Crossref 14. Durrer D, van Lier AAW, Büller J: Epicardial and intramural excitation in chronic myocardial infarction. Am Heart J 68:765-776, 1964.Crossref 15. Cranefield PF, Klein HO, Hoffman BF: Conduction of the cardiac impulse: I. Delay, block and one way block in depressed Purkinje fibers. Circ Res 28:199-219, 1971.Crossref 16. Durrer D, et al: Re-entry and ventricular arrhythmias in local ischemia and infarction of the intact dog heart. Proc Kon Nederl Akad Wet 74:321-332, 1971. 17. Wit AL, Cranefield PF, Hoffman BF: Slow conduction and re-entry in the ventricular conduction system: II. Single and sustain a circus movement in networks of canine and bovine Purkinje fibers. Circ Res 30:11-22, 1972.Crossref 18. Guérot C, et al: Tachycardie par réentré de branche à branche. Arch Mal Coeur 67:1-12, 1974. 19. Spurrell RAJ, Sowton E, Deuchar DC: Ventricular tachycardia in four patients evaluated by programmed electrical stimulation of the heart and treated in two patients by surgical division of the anterior radiation of the left bundle branch. Br Heart J 35:1014-1025, 1973.Crossref 20. Demoulin JC, Kulbertus HE: Histopathological examination of the concept of left hemiblock. Br Heart J 34:807-814, 1972.Crossref 21. Fontaine G, et al: Méthode d'étude expérimentale et clinique des syndromes de Wolff-Parkinson-White et d'ischémie myocardique par cartographie de la dépolarisation ventriculaire épicardiaque. Coeur Med Interne 12:105-114, 1973. 22. Rosen K, et al: The effects of propranolol on induction of A-V nodal re-entrant paroxysmal tachycardia. Circulation 48( (suppl 4) ):7, 1973.Crossref 23. Giardina EV, Bigger JTL: Procaine amide against re-entrant ventricular arrhythmias: Lengthening R-V intervals of coupled ventricular depolarizations as an insight into the mechanism of action of procaine amide. Circulation 48:959-970, 1973.Crossref 24. Boineau JP, Cox JL: Slow ventricular activation in acute myocardial infarction: A source of re-entrant premature ventricular contractions. Circulation 48:702-713, 1973.Crossref 25. Scherlag BJ, et al: Mechanisms of early and late arrhythmias due to myocardial ischemia and infarction. Circulation 46( (suppl 2) ):59, 1972. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Pathophysiology of Ventricular Tachycardia in Man

Archives of Internal Medicine , Volume 135 (3) – Mar 1, 1975

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Publisher
American Medical Association
Copyright
Copyright © 1975 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1975.00330030123012
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Abstract

Abstract Understanding the pathophysiologic mechanisms leading to ventricular arrhythmias seems indispensable for rational treatment. However, a detailed study of these mechanisms in the intact human heart is not possible at present. Therefore, we have to transpose knowledge obtained from observations on single cells, isolated muscle strips, and animal hearts to the human heart, with the inherent danger of making incorrect extrapolations. The recent introduction of programmed electrical stimulation of the heart gives us the opportunity to bridge a part of the gap by studying some aspects of the mechanisms of arrhythmias directly in the human heart. The purpose of this article is to review the possibilities and limitations of this technique to study ventricular tachycardia in man. As recently reviewed by Scherf and Schott,1 Bigger,2 and Watanabe and Dreifus,3 cardiac arrhythmias can result from different electrophysiologic mechanisms. These mechanisms can be classified as (1) abnormalities in impulse formation, References 1. Scherf D, Schott A: Extrasystoles and Allied Arrhythmias , ed 2. London, William Heinemann, 1973. 2. Bigger JT: Electrical properties of cardia muscle and possible causes of cardiac arrhythmias , in Dreifus LS, Likoff W (eds): Cardiac Arrhythmias . New York, Grune & Stratton, 1973, pp 13-34. 3. Watanabe Y, Dreifus LS: Arrhythmias: Mechanisms and pathogenesis , in Dreifus LS, Likoff W (eds): Cardiac Arrhythmias . New York, Grune & Stratton, 1973, pp 35-54. 4. Moe GK, Mendez C: The physiologic basis of reciprocal rhythms. Prog Cardiovasc Dis 8:461-482, 1966.Crossref 5. Durrer D, Roos JP: Epicardial excitation of the ventricles in a patient with W.P.W. syndrome. Circulation 35:15-21, 1967.Crossref 6. Durrer D, et al: The role of premature beats in the initiation and termination of supraventricular tachycardia in the Wolff-Parkinson-White syndrome. Circulation 36:644-662, 1967.Crossref 7. Coumel Ph, et al: Tachycardia permanente par rythme réciproque. Arch Mal Coeur 60:1830-1864, 1967. 8. Goldreyer BN, Bigger JT: Spontaneous and induced re-entrant tachycardia. Ann Intern Med 70:87-98, 1969.Crossref 9. Wellens HJJ: Electrical Stimulation of the Heart in the Study and Treatment of Tachycardias . Baltimore, University Park Press, 1971. 10. Wellens HJ, Schuilenburg RM, Durrer D: Electrical stimulation of the heart in patients with ventricular tachycardia. Circulation 46:216-225, 1972.Crossref 11. Wellens HJ, Lie KI, Durrer D: Further observations on ventricular tachycardia as studied by electrical stimulation of the heart. Circulation 49:647-653, 1974.Crossref 12. Wenckebach KF, Winterberg H: Die unregelmässige Herztätigkeit . Leipzig, Germany, Wilhelm Engelmann, 1927. 13. Sasyniuk BJ, Mendez C: A mechanism for re-entry in canine ventricular tissue. Circ Res 28:3-15, 1971.Crossref 14. Durrer D, van Lier AAW, Büller J: Epicardial and intramural excitation in chronic myocardial infarction. Am Heart J 68:765-776, 1964.Crossref 15. Cranefield PF, Klein HO, Hoffman BF: Conduction of the cardiac impulse: I. Delay, block and one way block in depressed Purkinje fibers. Circ Res 28:199-219, 1971.Crossref 16. Durrer D, et al: Re-entry and ventricular arrhythmias in local ischemia and infarction of the intact dog heart. Proc Kon Nederl Akad Wet 74:321-332, 1971. 17. Wit AL, Cranefield PF, Hoffman BF: Slow conduction and re-entry in the ventricular conduction system: II. Single and sustain a circus movement in networks of canine and bovine Purkinje fibers. Circ Res 30:11-22, 1972.Crossref 18. Guérot C, et al: Tachycardie par réentré de branche à branche. Arch Mal Coeur 67:1-12, 1974. 19. Spurrell RAJ, Sowton E, Deuchar DC: Ventricular tachycardia in four patients evaluated by programmed electrical stimulation of the heart and treated in two patients by surgical division of the anterior radiation of the left bundle branch. Br Heart J 35:1014-1025, 1973.Crossref 20. Demoulin JC, Kulbertus HE: Histopathological examination of the concept of left hemiblock. Br Heart J 34:807-814, 1972.Crossref 21. Fontaine G, et al: Méthode d'étude expérimentale et clinique des syndromes de Wolff-Parkinson-White et d'ischémie myocardique par cartographie de la dépolarisation ventriculaire épicardiaque. Coeur Med Interne 12:105-114, 1973. 22. Rosen K, et al: The effects of propranolol on induction of A-V nodal re-entrant paroxysmal tachycardia. Circulation 48( (suppl 4) ):7, 1973.Crossref 23. Giardina EV, Bigger JTL: Procaine amide against re-entrant ventricular arrhythmias: Lengthening R-V intervals of coupled ventricular depolarizations as an insight into the mechanism of action of procaine amide. Circulation 48:959-970, 1973.Crossref 24. Boineau JP, Cox JL: Slow ventricular activation in acute myocardial infarction: A source of re-entrant premature ventricular contractions. Circulation 48:702-713, 1973.Crossref 25. Scherlag BJ, et al: Mechanisms of early and late arrhythmias due to myocardial ischemia and infarction. Circulation 46( (suppl 2) ):59, 1972.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Mar 1, 1975

References