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Am J Physiol Heart Circ Physiol (September 26, 2002). doi:10.1152/ajpheart.00742.2002
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Articles in PresS, published online ahead of print September 26, 2002
Am J Physiol Heart Circ Physiol, 10.1152/ajpheart.00742.2002
Submitted on August 27, 2002
Accepted on September 17, 2002

On the Mechanism of the Probabilistic Nature of Ventricular Defibrillation Threshold

Masaaki Yashima1, Young-Hoon Kim1, Sean Armin1, Tsu-Juey Wu1, Yasushi Miyauchi1, William J Mandel1, Peng-Sheng Chen1, and Hrayr S Karagueuzian1*

1 Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA

* To whom correspondence should be addressed. E-mail: karagueuzian{at}cshs.org.

The probabilistic nature of ventricular defibrillation threshold (DFT) remains poorly understood. We hypothesized that shock outcome is a function of the amount of myocardium in its vulnerable period (VP). The endocardial surface of five isolated and perfused swine right ventricles (RV) was mapped with 477 bipolar electrodes during ventricular fibrillation (VF). Shock parameters and VF cycle length were not significantly different in the successful (S) (N=26) and failed (F) (N=26) trials. At the instant of the shock, the number of sites with 45-55 ms recovery was significantly smaller in the S than the F trials (P<0.04). No significant difference in the number of sites with recovery intervals outside the 45 to 55 ms range was seen in the S and F shocks. Endocardial action potential showed that a recovery time of 45 to 55 ms corresponded to the VP spanning -15 to -60 mV in 92% of the regenerative action potentials. We conclude that the probabilistic nature of the DFT is related to the amount of myocardium in its VP.




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