Resetting and Entrainment of Reentrant Arrhythmias: Part I: Concepts, Recognition, and Protocol for Evaluation: Surface ECG versus Intracardiac Recordings
Article first published online: 10 JAN 2013
©2013, The Authors. Journal compilation ©2013 Wiley Periodicals, Inc.
Pacing and Clinical Electrophysiology
Volume 36, Issue 4, pages 508–532, April 2013
How to Cite
ALMENDRAL, J., CAULIER-CISTERNA, R. and ROJO-ÁLVAREZ, J. L. (2013), Resetting and Entrainment of Reentrant Arrhythmias: Part I: Concepts, Recognition, and Protocol for Evaluation: Surface ECG versus Intracardiac Recordings. Pacing and Clinical Electrophysiology, 36: 508–532. doi: 10.1111/pace.12064
- Issue published online: 2 APR 2013
- Article first published online: 10 JAN 2013
- Manuscript Accepted: 24 NOV 2012
- Manuscript Revised: 14 OCT 2012
- Manuscript Received: 31 AUG 2012
Disclaimer: Supplementary materials have been peer-reviewed but not copyedited.
|pace12064-sup-0001-Video1.avi||2471K||Video 1. Computer simulation of a two-dimensional “figure-of-eight” reentrant arrhythmia, during which stimulation away from the circuit results in entrainment with manifest fusion. After initiation of reentry and two reentrant beats, pacing is initiated at the right margin of the planar model. The first paced beat does not reset the tachycardia, but the second beat does, and the third, fourth, and fifth beats entrain it. Note that there is manifest fusion in that a big area surrounding the pacing site is activated by the paced wavefront, but the rest of the model keeps activating as during tachycardia. Collision between these two activation wavefronts can be easily appreciated for each paced beat. For this and the subsequent videos, the Automata model was built with a rectangular bidimensional substrate representing a cardiac tissue planar section, subsequently subdivided in small cell groups. The reaction process of each cell is described by means of three different states and three transitions, according to a rest, activated, and refractory characteristics. The transitions in response to reaction were modeled using restitution curves of the action potential duration vs the diastolic interval and the conduction velocity. This model has been previously shown to be suitable for considering reentry, fibrillatory, and other arrhythmic mechanisms. The diffusion process was modeled with a mixed linear (impulse response of charge) and nonlinear (threshold effect) jointly considered at each integration step, which represents a significant improvement over our previous version.|
|pace12064-sup-0002-Video2.avi||1883K||Video 2. Computer simulation of entrainment without fusion. The format and reentrant arrhythmia are identical to that in Video 1. Likewise, reentry is initiated and, after two reentrant beats, pacing is initiated at a constant rate. In contrast to Video 1, the pacing site is now at the left margin of the planar model. In this case, the first paced beat resets the tachycardia, and the following entrain it. Note that, except for the small protected area located inside the two anatomical barriers, the remaining of the planar model activates during pacing in identical manner as expected if the tachycardia was absent (“fully paced” activation; see Video 3), so there is no overt fusion.|
|pace12064-sup-0003-Video3.avi||1791K||Video 3. Computer simulation of pacing from identical site as in Video 2, but in the absence of reentry. The format of the computer simulation is identical to that in Video 1.|
|pace12064-sup-0004-Video4.avi||1905K||Video 4. Computer simulation of concealed entrainment. The format and reentrant arrhythmia are identical to that in Video 1. Likewise, reentry is initiated and, after two reentrant beats, pacing is initiated at a constant rate. In contrast to Videos 1 and 2, the pacing site is now at the area located inside the two anatomical barriers. In this case, the first paced beat resets the tachycardia, and the following entrain it. Note that, except for a small part of the protected area inside the two anatomical barriers, the planar model activate during pacing in identical manner as during tachycardia, so there is no overt fusion.|
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