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J Appl Physiol 90: 287-298, 2001;
8750-7587/01 $5.00
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Vol. 90, Issue 1, 287-298, January 2001

Ventricular activation during sympathetic imbalance and its computational reconstruction

Martyn P. Nash1, Judith M. Thornton1, Claire E. Sears2, Anthony Varghese3, Mark O'Neill1, and David J. Paterson1

1 University Laboratory of Physiology, Oxford OX1 3PT; and 2 Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom; and 3 Institute for Mathematics and its Applications, University of Minnesota, Minneapolis, Minnesota 55455

We characterized the epicardial activation sequence during a norepinephrine (NE)-induced ventricular arrhythmia in anesthetized pigs and studied factors that modulated it. Subepicardial NE infusion caused the QRS complex to invert within a single beat (n = 35 animals, 101 observations), and the earliest epicardial activation consistently shifted to the randomly located infusion site (n = 14). This preceded right atrial activation, whereas the total ventricular epicardial activation time increased from 20 ± 4 to 50 ± 9 ms (P < 0.01). These events were accompanied by a ventricular tachycardia and a drop in left ventricular pressure, which were fully reversed after the infusion was stopped. Epicardial pacing at the infusion site mimicked all electrical and hemodynamic changes induced by NE. The arrhythmia was prevented by propranolol and abolished by cardiac sympathetic or vagal nerve stimulation. Focal automaticity was computationally reconstructed using a two-dimensional sheet of 256 × 256 resistively coupled ventricular cells, where calcium handling was abnormally high in the central region. We conclude that adrenergic stimulation to a small region of the ventricle elicits triggered automaticity and that computational reconstruction implicates calcium overload. Interventions that reduce spatial inhomogeneities of intracellular calcium may prevent this type of arrhythmia.

catecholamines; cardiac mapping; porcine heart; ventricular arrhythmia


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