Temporal characteristics of cardiac memory in humans: Vectorcardiographic quantification in a model of cardiac pacing

Wecke, Liliane; Gadler, Fredrik; Linde, Cecilia; Lundahl, Gunilla; Rosen, Michael R.; Bergfeldt, Lennart

doi:10.1016/j.hrthm.2004.10.010

Cited by 51 publications

(31 citation statements)

References 5 publications

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“…VCG was also used to study the development and resolution of CM induced by a week of maximal RV endocardial pacing in humans 20, reporting a resolution time of one month. While VCG records the manifestation of CM in the body-surface T-wave, ECGI maps cardiac activation and repolarization changes caused by the myocardial remodeling processes that underlie CM.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Memory in Patients With Wolff-Parkinson-White Syndrome

et al. 2008

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Background-Cardiac memory refers to a change in ventricular repolarization induced by and persisting for minutes to months after cessation of a period of altered ventricular activation (eg, resulting from pacing or preexcitation in patients with Wolff-Parkinson-White syndrome). ECG imaging (ECGI) is a novel imaging modality for noninvasive electroanatomic mapping of epicardial activation and repolarization. Methods and Results-Fourteen pediatric patients with Wolff-Parkinson-White syndrome and no other congenital disease,were imaged with ECGI a day before and 45 minutes, 1 week, and 1 month after successful catheter ablation. ECGI determined that preexcitation sites were consistent with sites of successful ablation in all cases to within a 1-hour arc of each atrioventricular annulus. In the preexcited rhythm, activation-recovery interval (ARI) was the longest (349Ϯ6 ms) in the area of preexcitation leading to high average base-to-apex ARI dispersion of 95Ϯ9 ms (normal is Ϸ40 ms). The ARI dispersion remained the same 45 minutes after ablation, although the activation sequence was restored to normal. ARI dispersion was still high (79Ϯ9 ms) 1 week later and returned to normal (45Ϯ6 ms) 1 month after ablation. Conclusions-The study demonstrates that ECGI can noninvasively localize ventricular insertion sites of accessory pathways to guide ablation and evaluate its outcome in pediatric patients with Wolff-Parkinson-White syndrome. Wolff-Parkinson-White is associated with high ARI dispersion in the preexcited rhythm that persists after ablation and gradually returns to normal over a period of 1 month, demonstrating the presence of cardiac memory. The 1-month time course is consistent with transcriptional reprogramming and remodeling of ion channels. (Circulation. 2008;118:907-915.)

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Section: Discussionmentioning

confidence: 99%

Cardiac Memory in Patients With Wolff-Parkinson-White Syndrome

et al. 2008

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“…Shvilkin and colleagues also described memory occurring consequent to the QRS widening induced by propafenone toxicity,36 showing a clinical corollary to Plotnikov et al’s earlier work on the interaction of memory and antiarrhythmic drugs in a canine model 37. Finally, Wecke and colleagues have systematically explored the clinical expression of cardiac memory in paced human subjects, detailing which vectorcardiographic measurements most consistently reflect the onset and offset of memory, as well as the time course of accumulation and resolution 38,39…”

Section: Clinical Updatesmentioning

confidence: 98%

Why T waves change: A reminiscence and essay

Rosen

2009

Heart Rhythm

Self Cite

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The following article is a personal reflection on my study of a subject which has long interested me. The subject is the T wave, and especially the T wave changes occurring as a marker of cardiac memory. My interest evolved over coffees that Mauricio Rosenbaum and I used to share at the Hotel Algonquin during his frequent trips from Buenos Aires to New York. There is something about the Algonquin, whose scarred wooden tabletops carry the imprints of Robert Benchley, Dorothy Parker, and the 1920's New York literati, and there was something about Mauricio-clinician-scientist, friend, and raconteur extraordinaire-that made his repeated challenges to me to "look at cardiac memory before you begin losing your own" irresistible. So began my personal voyage into trying to understand the T wave. My guideposts were the experiments of Wilson and Finch,(1) the astute observations of a host of investigators who followed, and Mauricio's iconoclastic insights. The story is far from over...I doubt I'll see the end of it in my lifetime. But if the beauty of discovery is in the voyage, then it has been - for me - a memorable trip.

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“…5 Subsequent studies by Rosenbaum and colleagues, and more recently by Wecke and colleagues, have delineated many of the basic features of the phenomenon of cardiac memory. [6][7][8] The onset of cardiac memory is rapid; as little as 15 minutes of pacing results in T wave changes. In humans, continuous pacing for approximately one week results in a steady state change in the T waves.…”

Section: Cardiac Memorymentioning

confidence: 99%

Mechanisms linking short- and long-term electrical remodeling in the heart .....is it a stretch?

Marrus

Nerbonne²

2008

Channels

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Ion channels play a central role in the normal electro-mechanical functioning of the heart and are implicated in a variety of disease processes. In response to electrical or mechanical perturbations, cardiac myocytes exhibit remarkable changes in the expression and/or the function of sarcolemmal ion channels, a process that is broadly described as electrical remodeling. This remodeling has beneficial, as well as adverse, effects on myocardial function, including increased risk of fatal arrhythmias. One specific example of cardiac electrical remodeling is cardiac memory, a phenomenon induced in the heart following abnormal myocardial activation patterns produced by artificial pacemakers. Recent studies have shed new light on the molecular mechanisms underlying cardiac memory and suggest intriguing parallels between cardiac memory and heart failure. In both situations, abnormal mechanical stretch of the myocardium results in direct alterations in ion channel properties, as well as in the activation of angiotensin-dependent signaling cascades. With time, altered gene transcription and protein synthesis lead to persistent changes in ion channel levels and activities, changes that can significantly impact normal cardiac function and increase arrhythmia susceptibility.

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Temporal characteristics of cardiac memory in humans: Vectorcardiographic quantification in a model of cardiac pacing

Cited by 51 publications

References 5 publications

Cardiac Memory in Patients With Wolff-Parkinson-White Syndrome

Cardiac Memory in Patients With Wolff-Parkinson-White Syndrome

Why T waves change: A reminiscence and essay

Mechanisms linking short- and long-term electrical remodeling in the heart .....is it a stretch?

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