Rotor Stability Separates Sustained Ventricular Fibrillation From Self-Terminating Episodes in Humans

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• 作者：David E. Krummen ; MD^&lowast ; ; ^&dagger ; ; ^{dkrummen@ucsd.edu" class="auth_mail} ; Justin Hayase ; MD^&lowast ; ; ^&dagger ; ; David J. Morris ; MD^&lowast ; ; ^&dagger ; ; Jeffrey Ho ; MD^&lowast ; ; ^&dagger ; ; Miriam R. Smetak ; BS^&dagger ; ; Paul Clopton ; MS^&dagger ; ; Wouter-Jan Rappel ; PhD^&lowast ; ; Sanjiv M. Narayan ; MD ; PhD^&lowast ; ; ^&dagger ;
• 关键词：arrhythmia mechanisms ; electrical rotors ; electrophysiology ; ventricular fibrillation
• 刊名：Journal of the American College of Cardiology
• 出版年：24 June 2014
• 年：2014
• 卷：63
• 期：24
• 页码：2712-2721
• 全文大小：2430 K

文摘

This study mapped human ventricular fibrillation (VF) to define mechanistic differences between episodes requiring defibrillation versus those that spontaneously terminate.

Background

VF is a leading cause of mortality; yet, episodes may also self-terminate. We hypothesized that the initial maintenance of human VF is dependent upon the formation and stability of VF rotors.

Methods

We enrolled 26 consecutive patients (age 64 ± 10 years, n = 13 with left ventricular dysfunction) during ablation procedures for ventricular arrhythmias, using 64-electrode basket catheters in both ventricles to map VF prior to prompt defibrillation per the institutional review board–approved protocol. A total of 52 inductions were attempted, and 36 VF episodes were observed. Phase analysis was applied to identify biventricular rotors in the first 10 s or until VF terminated, whichever came first (11.4 ± 2.9 s to defibrillator charging).

Results

Rotors were present in 16 of 19 patients with VF and in all patients with sustained VF. Sustained, but not self-limiting VF, was characterized by greater rotor stability: 1) rotors were present in 68 &plusmn; 17% of cycles in sustained VF versus 11 &plusmn; 18% of cycles in self-limiting VF (p < 0.001); and 2) maximum continuous rotations were greater in sustained (17 &plusmn; 11, range 7 to 48) versus self-limiting VF (1.1 &plusmn; 1.4, range 0 to 4, p < 0.001). Additionally, biventricular rotor locations in sustained VF were conserved across multiple inductions (7 of 7 patients, p = 0.025).

Conclusions

In patients with and without structural heart disease, the formation of stable rotors identifies individuals whose VF requires defibrillation from those in whom VF spontaneously self-terminates. Future work should define the mechanisms that stabilize rotors and evaluate whether rotor modulation may reduce subsequent VF risk.