Mechanisms of ventricular fibrillation induction by 60-Hz alternating current in isolated swine right ventricle

Olga Voroshilovsky, Zhilin Qu, Moon Hyoung Lee, Toshihiko Ohara, Gregory A. Fishbein, Hsun Lun A. Huang, Charles D. Swerdlow, Shien-Fong Lin, Alan Garfinkel, James N. Weiss, Hrayr S. Karagueuzian, Peng Sheng Chen*

*Corresponding author for this work

Research output: Contribution to journalArticle

18 Scopus citations

Abstract

Background - The mechanisms by which 60-Hz alternating current (AC) can induce ventricular fibrillation (VF) are unknown. Methods and Results - We studied 7 isolated perfused swine right ventricles in vitro. The action potential duration restitution curve was determined. Optical mapping techniques were used to determine the patterns of activation on the epicardium during 5-second 60-Hz AC stimulation (10 to 999 μA). AC captured the right ventricles at 100±65 μA, which is significantly lower than the direct current pacing threshold (0.77±0.45 mA, P<0.05). AC induced ventricular tachycardia or VF at 477±266 μA, when the stimulated responses to AC had (1) short activation CLs (128±14 ms), (2) short diastolic intervals (16±9 ms), and (3) short diastolic intervals associated with a steep action potential duration restitution curve. Optical mapping studies showed that during rapid ventricular stimulation by AC, a wave front might encounter the refractory tail of an earlier wave front, resulting in the formation of a wave break and VF. Computer simulations reproduced these results. Conclusions - AC at strengths less than the regular pacing threshold can capture the ventricle at fast rates. Accidental AC leak to the ventricles could precipitate VF and sudden death if AC results in a fast ventricular rate coupled with a steep restitution curve and a nonuniform recovery of excitability of the myocardium.

Original languageEnglish
Pages (from-to)1569-1574
Number of pages6
JournalCirculation
Volume102
Issue number13
DOIs
StatePublished - 26 Sep 2000

Keywords

  • Action potentials
  • Electrical stimulation
  • Electrophysiology
  • Mapping

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    Voroshilovsky, O., Qu, Z., Lee, M. H., Ohara, T., Fishbein, G. A., Huang, H. L. A., Swerdlow, C. D., Lin, S-F., Garfinkel, A., Weiss, J. N., Karagueuzian, H. S., & Chen, P. S. (2000). Mechanisms of ventricular fibrillation induction by 60-Hz alternating current in isolated swine right ventricle. Circulation, 102(13), 1569-1574. https://doi.org/10.1161/01.CIR.102.13.1569