Repolarization indicates electrical instability in ventricular arrhythmia originating from papillary muscle

EP Europace, vol. 25, pp. 688–697

Abstract

AIMS: Cardiac arrhythmia originating from the papillary muscle (PM) can trigger ventricular fibrillation (VF) and cause sudden cardiac death even in the absence of structural heart disease. Most premature ventricular contractions, however, are benign and hitherto difficult to distinguish from a potentially fatal arrhythmia. Altered repolarization characteristics are associated with electrical instability, but electrophysiological changes which precede degeneration into VF are still not fully understood. METHODS AND RESULTS: Ventricular arrhythmia (VA) was induced by aconitine injection into PMs of healthy sheep. To investigate mechanisms of degeneration of stable VA into VF in structurally healthy hearts, endocardial high-density and epicardial mapping was performed during sinus rhythm (SR) and VA. The electrical restitution curve, modelling the relation of diastolic interval and activation recovery interval (a surrogate parameter for action potential duration), is steeper in VA than in non-arrhythmia (ventricular pacing and SR). Steeper restitution curves reflect electrical instability and propensity to degenerate into VF. Importantly, we find the parameter repolarization time in relation to cycle length (RT/CL) to differentiate self-limiting from degenerating arrhythmia with high specificity and sensitivity. CONCLUSION: RT/CL may serve as a simple index to aid differentiation between self-limiting and electrically instable arrhythmia with the propensity to degenerate to VF. RT/CL is independent of cycle length and could easily be measured to identify electrical instability in patients.

Authors 13

1. Paula Münkler corresponding

   Universität Hamburg · University Medical Center Hamburg-Eppendorf · German Centre for Cardiovascular Research

   Affiliation as printed

   DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck , Berlin , Germany

   Department of Cardiology, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf , Martinistraße 52, 20246 Hamburg , Germany

2. Niklas Klatt

   Universität Hamburg · University Medical Center Hamburg-Eppendorf

   Affiliation as printed

   Department of Cardiology, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf , Martinistraße 52, 20246 Hamburg , Germany

3. Katharina Scherschel

   Universität Hamburg · University Medical Center Hamburg-Eppendorf · German Centre for Cardiovascular Research · Heinrich Heine University Düsseldorf

   Affiliation as printed

   Cardiac Neuro- and Electrophysiology Research Consortium (cNEP), Medical Faculty, Heinrich Heine University Düsseldorf , Kirchfeldstraße 40, 40217, Düsseldorf , Germany

   DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck , Berlin , Germany

   Department of Cardiology, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf , Martinistraße 52, 20246 Hamburg , Germany

   Division of Cardiology, Angiology and Intensive Care, Cardiac Neuro- and Electrophysiology Research Consortium (cNEP), EKV Düsseldorf , Düsseldorf , Germany

4. Paweł Kuklik

   Universität Hamburg · University Medical Center Hamburg-Eppendorf · Asklepios Klinik St. Georg · Asklepios

   Affiliation as printed

   Department of Cardiology, Asklepios Hospital St Georg , Lohmühlenstraße 5, 20099, Hamburg , Germany

   Department of Cardiology, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf , Martinistraße 52, 20246 Hamburg , Germany

5. Christiane Jungen Aachen Department of Cardiology, Leiden University Medical Center

   Universität Hamburg · Leiden University Medical Center · University Medical Center Hamburg-Eppendorf · German Centre for Cardiovascular Research

   Affiliation as printed

   DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck , Berlin , Germany

   Department of Cardiology, Leiden University Medical Center , Leiden , The Netherlands

   Department of Cardiology, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf , Martinistraße 52, 20246 Hamburg , Germany

6. Ersin Çavuş

   Universität Hamburg · University Medical Center Hamburg-Eppendorf

   Affiliation as printed

   Department of Cardiology, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf , Martinistraße 52, 20246 Hamburg , Germany

7. Christian Eickholt

   Universität Hamburg · University Medical Center Hamburg-Eppendorf · Asklepios Klinik St. Georg · Asklepios

   Affiliation as printed

   Department of Cardiology, Asklepios Hospital St Georg , Lohmühlenstraße 5, 20099, Hamburg , Germany

   Department of Cardiology, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf , Martinistraße 52, 20246 Hamburg , Germany

8. Jan Christoph

   University of California, San Francisco

   Affiliation as printed

   Cardiovascular Research Institute University of California, San Francisco , 555 Mission Bay Blvd South, 352S, San Francisco, CA , USA

9. Marc Daniel Lemoine

   Universität Hamburg · University Medical Center Hamburg-Eppendorf · German Centre for Cardiovascular Research

   Affiliation as printed

   DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck , Berlin , Germany

   Department of Cardiology, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf , Martinistraße 52, 20246 Hamburg , Germany

10. Torsten Christ

    University Medical Center Hamburg-Eppendorf · German Centre for Cardiovascular Research

    Affiliation as printed

    DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck , Berlin , Germany

    Institute of Experimental Pharmacology and Toxicology, University Medical Centre , Martinistraße 52, 20246 Hamburg , Germany

11. Stephan Willems

    Universität Hamburg · University Medical Center Hamburg-Eppendorf · Asklepios Klinik St. Georg · German Centre for Cardiovascular Research · Asklepios

    Affiliation as printed

    DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck , Berlin , Germany

    Department of Cardiology, Asklepios Hospital St Georg , Lohmühlenstraße 5, 20099, Hamburg , Germany

    Department of Cardiology, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf , Martinistraße 52, 20246 Hamburg , Germany

12. Paulus F. Kirchhof

    Universität Hamburg · University Medical Center Hamburg-Eppendorf · German Centre for Cardiovascular Research · University of Birmingham

    Affiliation as printed

    DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck , Berlin , Germany

    Department of Cardiology, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf , Martinistraße 52, 20246 Hamburg , Germany

    Institute of Cardiovascular Sciences, University of Birmingham , Birmingham , UK

13. Christian G. Meyer

    Universität Hamburg · University Medical Center Hamburg-Eppendorf · German Centre for Cardiovascular Research · Heinrich Heine University Düsseldorf

    Affiliation as printed

    Cardiac Neuro- and Electrophysiology Research Consortium (cNEP), Medical Faculty, Heinrich Heine University Düsseldorf , Kirchfeldstraße 40, 40217, Düsseldorf , Germany

    DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck , Berlin , Germany

    Department of Cardiology, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf , Martinistraße 52, 20246 Hamburg , Germany

    Division of Cardiology, Angiology and Intensive Care, Cardiac Neuro- and Electrophysiology Research Consortium (cNEP), EKV Düsseldorf , Düsseldorf , Germany