Author + information
- Received May 27, 1987
- Revision received February 24, 1988
- Accepted March 9, 1988
- Published online August 1, 1988.
- James E. Rosenthal, MD, FACC∗
- ↵∗Address for reprints: James E. Rosenthal, MD, Reingold ECG Center, Northwestern University Medical School, 310 East Superior Street, Chicago, Illinois 60611.
A recent study in 1 day old infarcted canine cardiac tissue demonstrated that variations in entrance and exit characteristics of depolarized spontaneous foci could profoundly affect their expression, resulting in behaviors such as modulated parasystole and entrainment, second and third degree exit block “autoentrainment” and annihilation (abrupt termination) of spontaneous activity. Foci with exit and entrance delay should also allow the occurrence of reflected reentry. To test this, the left circumflex coronary artery was ligated and, after 1 day, simultaneous microelectrode impalements were made in infarcted and uninfarcted portions of isolated ventricular preparations. Preparations were stimulated from the uninfarcted portions.
Reflected reentry was demonstrated in 5 of 11 preparations. It occurred when exit conduction delay resulted in reexcitation of the focus or, alternatively, when entrance conduction delay resulted in reexcitation of extrafocal tissue. Reflection occurred in which the action potentials were reexcited during phase 2 or 3, resulting in prolongation of action potential duration (type I), and in which reexcitation occurred after full or nearly full repolarization, resulting in a closely coupled extrasystole (type II). Electrotonic modulation and reflection could coexist, the type of behavior depending on the phase relation between focal and extrafocal action potentials. An example is illustrated in which type I reflection occurred only when preceding driven activity induced overdrive suppression of exit conduction from the focus. The results suggest that, in infarcted tissue, entrance and exit conduction delays to depolarized foci may form the basis for the occurrence of reflected reentry.
☆ This study was supported in part by a grant-in-aid from the American Heart Association, Dallas, Texas, with funds contributed in part by the Chicago Heart Association, Chicago, Illinois and by Grant RR-05370 from the U. S. Public Health Service, National Institutes of Health, Bethesda, Maryland.
- Received May 27, 1987.
- Revision received February 24, 1988.
- Accepted March 9, 1988.