Author + information
- Received September 12, 1997
- Revision received March 4, 1998
- Accepted March 17, 1998
- Published online July 1, 1998.
- Tsu-Juey Wu, MD∗,a,
- James J.C Ong, MD, FACCa,
- Chun Hwang, MD, FACCa,
- John J Lee, MD, FACCa,
- Michael C Fishbein, MD, FACCa,
- Lawrence Czer, MD, FACCa,
- Alfredo Trento, MDa,
- Carlos Blanche, MD, FACCa,
- Robert M Kass, MD, FACCa,
- William J Mandel, MD, FACCa,
- Hrayr S Karagueuzian, PhD, FACCa and
- Peng-Sheng Chen, MD, FACCa,* ()
- ↵*Address for correspondence: Dr. Peng-Sheng Chen, Division of Cardiology, Room 5342, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, California 90048
Objectives. We sought to evaluate the characteristics of wave fronts during ventricular fibrillation (VF) in human hearts with dilated cardiomyopathy (DCM) and to determine the role of increased fibrosis in the generation of reentry during VF.
Background. The role of increased fibrosis in reentry formation during human VF is unclear.
Methods. Five hearts from transplant recipients with DCM were supported by Langendorff perfusion and were mapped during VF. A plaque electrode array with 477 bipolar electrodes (1.6-mm resolution) was used for epicardial mapping. In heart no. 5, we also used 440 transmural bipolar recordings. Each mapped area was analyzed histologically.
Results. Fifteen runs of VF (8 s/run) recorded from the epicardium were analyzed, and 55 episodes of reentry were observed. The life span of reentry was short (one to four cycles), and the mean cycle length was 172 ± 24 ms. In heart no. 5, transmural scroll waves were demonstrated. The most common mode of initiation of reentry was epicardial breakthrough, followed by a line of conduction block parallel to the epicardial fiber orientation (34 [62%] of 55 episodes). In the areas with lines of block, histologic examination showed significant fibrosis separating the epicardial muscle fibers and bundles along the longitudinal axis of fiber orientation. The mean percent fibrous tissue in these areas (n = 20) was significantly higher than that in the areas without block (n = 28) (24 ± 7.5% vs. 10 ± 3.8%, p < 0.0001).
Conclusions. In human hearts with DCM, epicardial reentrant wave fronts and transmural scroll waves were present during VF. Increased fibrosis provides a site for conduction block, leading to the continuous generation of reentry.
↵∗ Present address: Veterans General Hospital, Taichung, Taiwan.
☆ This study was performed during the tenure of an American College of Cardiology/Merck Research Fellowship (Drs. Ong and Hwang), a National Institutes of Health Individual Research Service Award (Dr. Ong), a National Institutes of Health Clinical Scientist Development Award (Dr. Ong), an ECHO Foundation Award (Dr. Karagueuzian) and an American Heart Association/Wyeth-Ayerst Established Investigatorship Award (Dr. Chen). The study was also supported in part by Specialized Center of Research (SCOR) Grant in Sudden Death P50HL52319 and FIRST Award R29HL50259 from the National Institutes of Health, Bethesda, Maryland and by the Ralph M. Parsons Foundation, Los Angeles, California.
- Received September 12, 1997.
- Revision received March 4, 1998.
- Accepted March 17, 1998.
- American College of Cardiology