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Title: | Noninvasive detection of spatiotemporal activation-repolarization interactions that prime idiopathic ventricular fibrillation | Authors: | Cluitmans, Matthijs Bear, Laura Nguyên, Uyên VAN REES, Bianca STOKS, Job Ter Bekke, Rachel Mihl, Casper Heijman, Jordi Lau, Kevin Vigmond, Edward Bayer, Jason Belterman, Charly Abell, Emma Labrousse, Louis Rogier, Julien Bernus, Olivier Haïssaguerre, Michel Hassink, Rutger DUBOIS, Joris Coronel, Ruben VOLDERS, Ann |
Issue Date: | 2021 | Publisher: | AMER ASSOC ADVANCEMENT SCIENCE | Source: | Science Translational Medicine, 13 (620) (Art N° eabi9317) | Abstract: | A comprehensive understanding of the interaction between triggers and electrical substrates leading to ventric-ular fibrillation (VF) and sudden cardiac arrest is lacking, and electrical substrates are difficult to detect and localize with current clinical tools. Here, we created repolarization time (RT) dispersion by regional drug infusion in perfused explanted human (n = 1) and porcine (n = 6) hearts and in a computational model of the human ventricle. Arrhythmia induction was tested with a single ventricular extrastimulus applied at the early or late RT region. Arrhythmias could only be induced from early RT regions. Vulnerability to VF increased with RT gradient steep-ness and with larger areas of early RT, but not with markers on the body-surface electrocardiogram. Noninvasive electrocardiographic imaging was performed in survivors of idiopathic VF (n = 11), patients with frequent premature ventricular complexes (PVCs) but no history of sudden cardiac arrest (n = 7), and controls (n = 10). In survivors of idiopathic VF, RT gradients were steeper than in controls, without differences in the clinical electrocardiogram, consistent with the ex vivo results. Patients with idiopathic VF also showed local myocardial regions with distinctly early-versus-late RT that were more balanced in size than in controls. Premature beats originated more often from the early RT regions in idiopathic VF survivors than in patients with frequent PVCs only. Thus, idiopathic VF emerges from the spatiotemporal interaction of a premature beat from an early-repolarization region with critical repolarization dispersion in that region. Electrocardiographic imaging can uncover the co-occurrence of these abnormalities. | Document URI: | http://hdl.handle.net/1942/37357 | ISSN: | 1946-6234 | e-ISSN: | 1946-6242 | DOI: | 10.1126/scitranslmed.abi9317 | ISI #: | WOS:000720389300004 | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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2021_Cluitmans_Noninvasive_Detection_Interactions_Idiopathic_VF.pdf Restricted Access | Published version | 1.34 MB | Adobe PDF | View/Open Request a copy |
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