Effect of pacing duration on right ventricular effective refractory period in man

Theisen, K.; Vogler, Astrid C.; Kotzur, J.

doi:10.1007/bf01721776

Cited by 1 publication

(1 citation statement)

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“…However, VERPs can be selectively affected by factors that need not similarly affect APD. These include the numbers, and time courses of activation or inactivation, of Na + and K + channels; the amplitude and duration of the applied stimuli [46]; and conditions of myocyte damage or ischaemia. Na + channel dysfunction therefore could well alter VERP differently from APD.…”

Section: Introductionmentioning

confidence: 99%

Refractory dispersion promotes conduction disturbance and arrhythmias in a Scn5a +/− mouse model

Martin

Grace

Huang

2011

Pflugers Arch - Eur J Physiol

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Accentuated right ventricular (RV) gradients in action potential duration (APD) have been implicated in the arrhythmogenicity observed in Brugada syndrome in studies assuming that ventricular effective refractory periods (VERPs) vary in concert with APDs. The present experiments use a genetically modified mouse model to explore spatial heterogeneities in VERP that in turn might affect conduction velocity, thereby causing arrhythmias. Activation latencies, APDs and VERPs recorded during programmed S1S2 protocols were compared in RV and left ventricular (LV) epicardia and endocardia of Langendorff-perfused wild-type (WT) and Scn5a+/− hearts. Scn5a+/− and WT hearts showed similar patterns of shorter VERPs in RV than LV epicardia, and in epicardia than endocardia. However, Scn5a+/− hearts showed longer VERPs, despite shorter APD90s, than WT in all regions examined. The pro- and anti-arrhythmic agents flecainide and quinidine increased regional VERPs despite respectively decreasing and increasing the corresponding APD90s particularly in Scn5a+/− RV epicardia. In contrast, Scn5a+/− hearts showed greater VERP gradients between neighbouring regions, particularly RV transmural gradients, than WT (9.1 ± 1.1 vs. 5.7 ± 0.5 ms, p < 0.05, n = 12). Flecainide increased (to 21 ± 0.9 ms, p < 0.05, n = 6) but quinidine decreased (to 4.5 ± 0.5 ms, p < 0.05, n = 6) these gradients, particularly across the Scn5a+/− RV. Finally, Scn5a+/− hearts showed greater conduction slowing than WT following S2 stimuli, particularly with flecainide administration. Rather than arrhythmogenesis resulting from increased transmural repolarization gradients in an early, phase 2, reentrant excitation mechanism, the present findings implicate RV VERP gradients in potential reentrant mechanisms involving impulse conduction slowed by partial refractoriness.

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Section: Introductionmentioning

confidence: 99%