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Clin Res Cardiol (2021) DOI DOI https://doi.org/10.1007/s00392-021-01843-w |
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DGK-Abstract-Preis 2021: |
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| P. Münkler1, N. Klatt2, K. Scherschel3, P. Kuklik1, C. Jungen1, C. Eickholt4, R. Riedel5, S. Willems4, C. Meyer3 | ||
| 1Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; 2Klink für Innere Medizin und Kardiologie, Schön Klinik Neustadt, Neustadt in Holstein; 3Klinik für Kardiologie, Evangelisches Krankenhaus Düsseldorf, Düsseldorf; 4Kardiologie, Asklepios Klinik St. Georg, Hamburg; 5Max Planck Institute for Evolutionary Biology, Plön; | ||
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Background Ventricular arrhythmia (VA) in structurally normal hearts is usually benign. However, when originating from papillary muscles and Purkinje fibres, VA can be a potential trigger of ventricular fibrillation. Papillary muscle arrhythmia occurs also in structurally normal hearts and presently, no electrophysiological parameters are known to reflect the potential to degenerate into ventricular fibrillation. Therefore, risk stratification for these patients remains difficult. Methods We developed an ovine model for ventricular arrhythmia in structurally normal hearts. Aconitine was injected in the papillary muscle in an open-chest setting to induce focal ventricular arrhythmia which degenerated into ventricular fibrillation. Endocardial high-density-mapping and epicardial mapping was employed. Characteristics of propagation and repolarization determined by unipolar electrograms were analyzed in order to identify parameters associated with degeneration of VA into ventricular fibrillation. We analyzed electrical restitution which models the relation of diastolic interval and activation-recovery-interval. A small change of diastolic interval leading to a strong change in activation-recovery-interval is considered a marker of electrical instability. A steeper electrical restitution curve is considered to predispose to degeneration of a regular heart rhythm into VF. Furthermore, we analyzed dispersion of repolarization and compared ventricular arrhythmia to sinus rhythm and paced rhythm as well as self-limiting arrhythmia to degenerating arrhythmia. Results VA was induced via aconitine injection in the anterior papillary muscle of female sheep (n=12). During focal arrhythmia faster conduction occurred in longitudinal and basal direction at the level of papillary muscle compared to transversal and apical direction. As a sign of electrical instability in ventricular arrhythmia, we found a steeper electrical restitution curve in ventricular arrhythmia compared to sinus rhythm or paced rhythm. Repolarization time in relation to cycle length (RT/CL), which can easily be measured during electrophysiological procedures, predicted degeneration into ventricular fibrillation. Thus, self-limiting ventricular arrhythmia could be differentiated from degenerating arrhythmia. Activation-recovery interval and repolarization time exhibit higher dispersion per beat in ventricular arrhythmia preceding degeneration into ventricular fibrillation than self-limiting arrhythmia. Increasing spatial resolution of the model for restitution relation did not increase performance in differentiating degenerating and self-limiting arrhythmia. In our model , the relation of repolarization and cycle length during ventricular arrhythmia and greater dispersion of repolarization preceding degeneration are predictive indicators of degeneration into ventricular fibrillation. Conclusion A simple index of the (RT/CL) may be sufficient to differentiate differentiation between self-limiting and electrically instable arrhythmia with a propensity to degenerate to ventricular fibrillation. |
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https://dgk.org/kongress_programme/jt2021/aP746.html |