Rate and rhythm dependent vulnerability of the human ventricular myocardium

Fleischmann, D.; Marschall, H.-U.; Bakker, Jacques M.T. de

doi:10.1007/bf01907821

Cited by 13 publications

(3 citation statements)

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“…This observation was described in some detail in a previous publication (8) where we substantiated our assumption that the occurrence of the V3 beats is an artificially induced but physiological response of the human ventricle based on a local re-entry mechanism. However, a slight variation of the stimulation procedure e.g.…”

Section: Discussionsupporting

confidence: 87%

“…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: 86%

“…In the light of these in vitro experiments we (3,7,8) localize the increasing delay of the retrograde intraventricular conduction time $2H2 ( fig. 2, 3) during premature RV stimulation at the junction of the ventricular myocardium and the distal Purklnje system.…”

Section: The Echo Zonementioning

confidence: 98%

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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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Section: Discussionsupporting

confidence: 87%

supporting

confidence: 86%