Three‐Dimensional Mapping of Earliest Activation after Near‐Threshold Ventricular Defibrillation Shocks

Chattipakorn, Nipon; Fotuhi, Parwis; Chattipakorn, Siriporn C.; Ideker, Raymond E.

doi:10.1046/j.1540-8167.2003.02397.x

Cited by 56 publications

(57 citation statements)

References 20 publications

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“…First transmural myocardial post-shock activation was recorded with an LV electrode in all 48 episodes and with one of the three most epicardial unipolar electrograms in 98% (47/48) of these episodes. First post-shock local myocardial activation arose in the LV apex and lateral free wall 11,16 in 88% of the instances, which is the region from which transmural bipolar electrograms were recorded.…”

Section: Resultsmentioning

confidence: 99%

“…Since the first recorded activations in pigs tend to arise from the LV apex and lateral free wall in the subepicardial tissue for this electrode configuration, 11,16 needles were placed more densely in these regions than in the LV base and RV. Thirty-two 12 electrode plunge needles were inserted into the lateral LV free wall and apex with approximately 3−5 mm spacing between needles.…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…The needle locations were recorded with a 3D arm digitizer, and the locations of electrodes along each needle were determined, as previously described. 11,22 …”

Section: Localization Of Needlesmentioning

confidence: 99%

“…[11][12][13][14][15] Previous defibrillation studies have demonstrated that in pigs first postshock activation tends to arise closer to the epicardium than the endocardium.11 , 16 In pigs, Purkinje fibers traverse the ventricular wall and extend nearly to the epicardial surface. [17][18][19] Thus, the subepicardial location of the first recorded post-shock electrical activation in pigs raises the possibility that the earliest post-shock activation arises in the specialized conduction system.…”

Section: Introductionmentioning

confidence: 99%

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Transmural and endocardial Purkinje activation in pigs before local myocardial activation after defibrillation shocks

et al. 2007

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Section: Resultsmentioning

confidence: 99%

Section: Surgical Proceduresmentioning

confidence: 99%

“…The needle locations were recorded with a 3D arm digitizer, and the locations of electrodes along each needle were determined, as previously described. 11,22 …”

Section: Localization Of Needlesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transmural and endocardial Purkinje activation in pigs before local myocardial activation after defibrillation shocks

et al. 2007

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“…It is most often caused by a lethal cardiac arrhythmia known as ventricular fibrillation (VF) (27,(30)(31)(32)(33)(34)(35). VF has been characterized as a rapid, disorganized, and asynchronous contraction of ventricular muscle, which causes the failure of the pumping function of the heart, leading to vital organ failure and causing death within minutes (36)(37)(38)(39).…”

Section: Sildenafil Citrate and Sudden Cardiac Deathmentioning

confidence: 99%

Effect of sildenafil citrate on the cardiovascular system

Shinlapawittayatorn

Chattipakorn

2005

Braz J Med Biol Res

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Sildenafil citrate is a drug commonly used to manage erectile dysfunction. It is designated chemically as 1- [[3-(6,7-dihydro-1-methyl-7-oxo-3-propyl-1H-pyrazolo[4,3-d]pyrimidin-5-yl)-4 ethoxyphenyl] sulfonyl]-4-methylpiperazine citrate (C 22 H 30 N 6 O 4 S). It is a highly selective inhibitor of cyclic guanine monophosphate-specific phosphodiesterase type 5. In late March through mid-November 1998, the US Food and Drug Administration (FDA) published a report on 130 confirmed deaths among men (mean age, 64 years) who received prescriptions for sildenafil citrate, a period during which >6 million outpatient prescriptions (representing about 50 million tablets) were dispensed. The US FDA recently reported that significant cardiovascular events, including sudden cardiac death, have occurred in men with erectile dysfunction who were taking sildenafil citrate. These reports have raised concerns that sildenafil citrate may increase the risk of cardiovascular events, particularly fatal arrhythmias, in patients with cardiovascular disease. In the past few years, the cardiac electrophysiological effects of sildenafil citrate have been investigated extensively in both animal and clinical studies. According to extensive data available to date, sildenafil citrate has been shown to pose minimal cardiovascular risks to healthy people taking this drug. Some precautions are needed for patients with cardiovascular diseases. However, the only absolute contraindication for sildenafil citrate is the concurrent use of nitrates. This article is intended to review sildenafil citrate's cardiovascular effects, as well as current debates about its arrhythmogenic effects.

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Mechanisms of Defibrillation

Dosdall¹,

Huang²,

Ideker³

2008

Ventricular Arrhythmias and Sudden Cardiac Death

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Electrical shock has been the one effective treatment for ventricular fibrillation for several decades. With the advancement of electrical and optical mapping techniques, histology, and computer modeling, the mechanisms responsible for defibrillation are now coming to light. In this review, we discuss recent work that demonstrates the various mechanisms responsible for defibrillation. On the cellular level, membrane depolarization and electroporation affect defibrillation outcome. Cell bundles and collagenous septae are secondary sources and cause virtual electrodes at sites far from shocking electrodes. On the whole-heart level, shock field gradient and critical points determine whether a shock is successful or whether reentry causes initiation and continuation of fibrillation.

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Three‐Dimensional Mapping of Earliest Activation after Near‐Threshold Ventricular Defibrillation Shocks

Abstract: Following near-DFT50 shocks, the first postshock cycles did not arise by macroreentry. Instead, they originated from a true focus or microreentry, most commonly near the epicardium.

Cited by 56 publications

References 20 publications

Transmural and endocardial Purkinje activation in pigs before local myocardial activation after defibrillation shocks

Transmural and endocardial Purkinje activation in pigs before local myocardial activation after defibrillation shocks

Effect of sildenafil citrate on the cardiovascular system

Mechanisms of Defibrillation

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