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Prearrhythmia: changes preceding arrhythmia, new aspects by epicardial mapping.

S Dhein1, A Müller, W Klaus

  • 1Institute of Pharmacology, University of Cologne, FRG.

Basic Research in Cardiology
|May 1, 1990
PubMed
Summary

Arrhythmia is not sudden; early electrophysiological changes precede its onset. Computer mapping of rabbit hearts revealed critical declines in activation pattern similarity, indicating a "prearrhythmia" state before heart rhythm disturbances.

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Area of Science:

  • Cardiovascular Electrophysiology
  • Computational Biology
  • Cardiac Arrhythmia Research

Background:

  • Cardiac arrhythmia onset is debated: a sudden event or preceded by early signs.
  • Understanding pre-arrhythmic electrophysiological conditions is crucial for predicting and preventing arrhythmias.

Purpose of the Study:

  • To investigate electrophysiological conditions preceding arrhythmia onset.
  • To determine if arrhythmia is a sudden event or has identifiable early indicators.

Main Methods:

  • Developed a high-resolution (4 kHz/channel, 1 mm) computer-assisted mapping system with 256 AgCl electrodes.
  • Recorded unipolar epicardial potentials on isolated Langendorff-perfused rabbit hearts.
  • Analyzed epicardial activation patterns, breakthrough points (BTP), and activation vectors under control, arrhythmogenic (low K+, ouabain), and manifest arrhythmia conditions.

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Main Results:

  • Under control conditions, 80% of breakthrough points (BTP) and 30% of activation vectors remained stable.
  • Arrhythmogenic conditions (reduced extracellular K+ or ouabain) caused progressive, concentration-dependent decreases in BTP and vector similarity.
  • Critical thresholds for arrhythmia onset identified: 45% BTP similarity and 18% vector field similarity.

Conclusions:

  • Arrhythmia is preceded by a distinct electrophysiological state characterized by a disturbed activation pattern, termed 'prearrhythmia'.
  • This study provides evidence that cardiac arrhythmias develop progressively rather than occurring abruptly.