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Rotors anchored by refractory islands drive torsades de pointes in an experimental model of electrical storm
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Description
Electrical storm (ES) is a life-threatening emergency in patients at high risk of ventricular tachycardia/ventricular fibrillation (VF), but the pathophysiology and molecular basis are poorly understood.The purpose of this study was to explore the electrophysiological substrate for experimental ES.A model was created by inducing chronic complete atrioventricular block in defibrillator-implanted rabbits, which recapitulates QT prolongation, torsades des pointes (TdP), and VF episodes.Optical mapping revealed island-like regions with action potential duration (APD) prolongation in the left ventricle, leading to increased spatial APD dispersion, in rabbits with ES (defined as ≥3 VF episodes/24 h). The maximum APD and its dispersion correlated with the total number of VF episodes in vivo. TdP was initiated by an ectopic beat that failed to enter the island and formed a reentrant wave and perpetuated by rotors whose centers swirled in the periphery of the island. Epinephrine exacerbated the island by prolonging APD and enhancing APD dispersion, which was less evident after late NaA tissue island with enhanced refractoriness contributes to the generation of drifting rotors that underlies ES in this model. Na
Journal
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- Heart Rhythm
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Heart Rhythm 19 (2), 318-329, 2022-02
Elsevier BV
