The slippery slope of human ventricular arrhythmias

Ventricular fibrillation and defibrillation

Cardiac arrest in children is not often due to a disturbance in rhythm that is amenable to electrical defibrillation, contrary to the situation in adults. When a shockable rhythm is present, defibrillation using an external electric shock applied at an early stage after pre-oxygenation and chest compressions is of proven efficacy. Success at conversion of ventricular fibrillation is dependent on the delay before delivering the shock and defibrillation efficiency, which is itself a function of thoracic impedance, energy dose and waveform.

Action potential duration restitution portraits of mammalian ventricular myocytes: role of calcium current

Construction of the action potential duration (APD) restitution portrait allows visualization of multiple aspects of the dynamics of periodically paced myocytes at various basic cycle lengths (BCLs). For the first time, we obtained the restitution portrait of isolated rabbit and guinea pig cardiac ventricular myocytes and analyzed the time constant, tau, of APD accommodation and the slopes of different types of restitution curves, Sdyn and S12, measured at varying BCLs. Our results indicate that both tau and the individual slopes are species and pacing dependent. In contrast, the mutual relationship between slopes Sdyn and S12 does not depend on pacing history, being a generic feature of the species. In addition, the maximum slope S12, measured in the restitution portrait at the lowest BCL, predicts the onset of alternans. Further, we investigated the role of the L-type calcium current, ICa-L, in the restitution portrait. We found that ICa-L dramatically affects APD accommodation, as well as the individual slopes Sdyn and S12 measured in the restitution portrait. However, peak calcium current plays a role only at small values of BCL. In conclusion, the results demonstrate that the restitution portrait is a powerful technique to investigate restitution properties of periodically paced cardiac myocytes and the onset of alternans, in particular. Moreover, the data also show that ICa-L plays a crucial role in multiple aspects of cardiac dynamics measured through the restitution portrait.