Border zone repolarization duration as a predictor of early ischemic ventricular fibrillation

Abstract

Ventricular fibrillation (VF) is a dangerous complication of acute myocardial infarction. Within an episode of acute ischemia, VFs are clustered into early (1A) and delayed (1B) phases based on different mechanisms. Our previous work demonstrated that prolonged repolarization duration in the border zone predisposed to VF development. A prolongation of action potential duration in the affected area is a frequent though not inevitable change at the very beginning of ischemia. However, the role of this phenomenon in arrhythmogenesis is unclear. The objective of the present study was to evaluate an association between early (1A phase) VF with repolarization duration in the border zone in an experimental porcine myocardial infarction model.Myocardial ischemia was induced in 19 anesthetized domestic pigs by ligation of the left anterior descending (n=9) or left circumflex (n=10) coronary arteries. Epicardial mapping was done with a 64‐lead epicardial array placed on the affected area with adjacent regions. Recordings were done in the baseline state and during ischemia with a custom‐designed system (16 bits; bandwidth 0.05 to 1000 Hz; sampling rate 4000 Hz). Local activation time (AT) and end of repolarization time (RT) were measured in each epicardial lead as the instants of a dV/dt minimum during QRS‑complex and dV/dt maximum during T‑wave, respectively. Activation‐repolarization interval (ARI, a surrogate for action potential duration) was taken as a rate‐corrected difference between RT and AT. Dispersion of repolarization (DOR) was calculated as a difference between the latest and earliest RTs throughout all recorded epicardial leads.Ten early VF episodes developed during first minutes of ischemia (1‐8 min). In logistic regression analysis, VF incidence was associated with ARI duration in the border zone (regression coefficient 1.02, 95% CI 1.003‐1.037, p=0.023), but not DOR (regression coefficient 1.005, 95%CI 0.990‐1.021, p=0.508) during first ten minutes of ischemia. In multivariate logistic regression analysis (baseline ARI duration vs the fact of ARI prolongation), VF incidence was associated only with the baseline ARI duration (regression coefficient 1.025, 95%CI 1.007‐1.044, p=0.005).Our data demonstrated the role of the prolonged repolarization duration in the development of 1A phase VF, which was independent of DOR and related to its baseline duration. Since the border zone is by definition at least partly accessible for blood flow, it may present a target for VF prevention therapy in a setting of acute myocardial ischemia.