Reentry Mechanism Within the His-Purkinje-System in Man During Extrasystolic Stimulation of the Right Ventricle

Fleischmann, D.; T, Pop; Bakker, Jacques M.T. de

doi:10.1007/978-3-642-66356-7_20

Cited by 6 publications

(6 citation statements)

References 35 publications

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“…As we found a correlation between the incidence of ventricular vulnerability after premature RV stimulation and the prolongation (19) of the retrograde intraventricular conduction time $2H2 we (13,19,20) favour in accordance with other investigators (12) a re-entry mechanism underlying the genesis of the repetitive ventricular beats. The significant difference in the frequency of ventricular vulnerability during the RA versus the RV drive rhythm argues against an abnormal and enhanced impulse formation initiated by the premature RV stimuli.…”

Section: The Origin Of the Repetitive Beats; Re-entry Mechanism Versusupporting

confidence: 90%

“…In the preceding paragraphs we substantiated our assumption that the prematurely elicited and retrogradely propagating RV impulse Sz will mainly be delayed traversing the distal Purkinje fibers (20,21). Extreme and critical prolongation of the retrograde intraventricular conduction time $2H2, therefore, probably signals critically and extremely reduced conduction velocity of the impulse $2 within the distal Purkinje system.…”

Section: The Origin Of the Repetitive Beats; Re-entry Mechanism Versusupporting

confidence: 71%

“…The striking difference in the duration of the $2H2 intervals after premature RV stimulation during the RV and the RA drive rhythm supports the hypothesis that the main delay of the retrograde conduction time $2H2 is confined in the distal Purkinje system (20,21). If the main delay of retrograde conduction from the site of stimulation within the ventricle to Basic Research in Cardioiogy, VoI.…”

Section: The Conduction Delay During Retrograde Propagation Of Sz Witsupporting

confidence: 59%

“…Retrograde conduction times from the site of stimulation to the bundle of His are shortened during premature RV stimulation with increasing heart rates (16,19). Retrograde conduction times from the site of stimulation to the bundle of His are shortened during premature RV stimulation with increasing heart rates (16,19).…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Rate and rhythm dependent vulnerability of the human ventricular myocardium

Fleischmann¹,

Marschall²,

Bakker³

1979

Basic Res Cardiol

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Section: The Origin Of the Repetitive Beats; Re-entry Mechanism Versusupporting

confidence: 90%

Section: The Origin Of the Repetitive Beats; Re-entry Mechanism Versusupporting

confidence: 71%

Section: The Conduction Delay During Retrograde Propagation Of Sz Witsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Rate and rhythm dependent vulnerability of the human ventricular myocardium

Fleischmann¹,

Marschall²,

Bakker³

1979

Basic Res Cardiol

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“…We confirmed (2,3,8,13) the strong dependency of the V 3 phenomenon upon the critically prolonged retrograde intraventricular conduction time S2H 2 which was first described by Akhtar et al (I): Spontaneous ventricufar extrasystoles after premature RV test pulses occurred only after long S2H 2 intervals at all heart rates tested ( fig. 5), V3-beats did not occur during conduction failure of the test impulse within the specialized conduction system ( fig.…”

supporting

confidence: 87%

Observations on the mechanism of human ventricular vulnerability during premature stimulation

Fleischmann¹,

T²,

Wiesener³

et al. 1979

Basic Res Cardiol

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Sum_marySpontaneous ventricular extrasystoles (V3-beats) occur frequently after premature ventricular stimuli induced during a paced ventricular rhythm. The V3 phenomenon was observed in, 100 of 158 patients (63.3%) with and without heart disease being studied for the evaluation of various rhythm disorders. In patients with an old myocardial infarction there was an increased tendency to exhibit short ventricular salvos (V3-V 5 beats) after prematurely elicited test pulses. V~-beats occurred less frequently in patients with a bundle branch block than in patients with normal intraventricular conduction.The statistical analysis of several variables obtained during the investigation revealed that the frequency and the appearance time of the V 3 beats and the vulnerable period of the cardiac cycle are related to a critical delay of the retrograde Purkinje-His conduction time of the premature test pulse, the basic rate of the drive rhythm and the state of excitability of the ventricular myocardium. The results strongly suggest a re-entry mechanism generating the spontaneous ventricular extrasystoles. The main delay of conduction of the premature test pulse seems to be localized not within the working myocardial fibers or the proximal His-Purkinje system but rather within the distal Purkinje fiber system. Therefore, the re-entry pathway of the V~ beats is thought to be confined to the right ventricular Purkinje fiber network near the site of stimulation.Clinically, it can be deduced that an artificially induced ventricular re-entry beat is tolerated and extinguished in the stable heart by physiological protective mechanisms. In the diseased heart, however, an increased state of fiber inhomogenity may be generated by the V 3 beat leading to recurrent re-entry impulses.Premature right ventricular stimulation during a paced ventricular rhythm has become a routine procedure in clinical electrophysiology. Early test pulses may lead to spontaneous ventricular extrasystoles. These beats have to be considered as a variant form of human ventricular vulnerability. Usually, only one spontaneous ventricular extrasystole *) Supported by Deutsche Forschungsgemeinschaft SFB 109 807

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Elektrotherapie bei akutem Myokardinfarkt

Grosser

1979

Thema: Der Frische Herzmuskelinfarkt Herzruptur

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Reentry Mechanism Within the His-Purkinje-System in Man During Extrasystolic Stimulation of the Right Ventricle

Cited by 6 publications

References 35 publications

Rate and rhythm dependent vulnerability of the human ventricular myocardium

Rate and rhythm dependent vulnerability of the human ventricular myocardium

Observations on the mechanism of human ventricular vulnerability during premature stimulation

Elektrotherapie bei akutem Myokardinfarkt

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