Evidence of three-dimensional scroll waves with ribbon-shaped filament as a mechanism of ventricular tachycardia in the isolated rabbit heart.

Abstract

Rotating vortices have been observed in excitable media of different nature. Vortices may sustain life or kill in different species, by underlining morphogenesis in Dictiostelium discoideum during starvation, or arrhythmias during sudden cardiac death in mammals. Investigation of vortices in the heart has been limited by two-dimensional experimental techniques. In contrast, three-dimensional (3D) Belousov-Zhabotinsky excitable medium and mathematical models have been shown to sustain scroll-shaped waves. The heart is a 3D structure; therefore, scroll waves may underlie cardiac arrhythmias. We used potentiometric dye and optical mapping techniques to study vortices during ventricular arrhythmias. The core of all observed vortices were linearly shaped and > or = 9 mm (48 episodes, six hearts). As shown by Allessie et al. in the rabbit atrium, ventricular signals recorded within 1 to 2 mm from the line of block were dual humped, suggesting there is electrotonic interaction across the line of block. We hypothesized that the line of block represents epicardial intersection of ribbon-shaped filaments, which in some cases may be oriented under an angle or parallel to the epicardium. In 14 episodes we observed dual-humped optical recordings at one side of the line of block at a distance up to 12 mm. The two humps may represent the signatures of two activation wavefronts propagating above and below the filament, which in this area is close to the epicardial surface. The activation sequence of the two waves is consistent with the idea of a scroll wave with ribbon-like filament. Our data provide new insights into the shape and dynamics of the filament of the 3D scroll wave, which underlies the mechanism of ventricular tachycardia in the rabbit heart. The filament of the scroll wave may be ribbon shaped, with a significant width > or = 9 mm and a thickness of 1 to 2 mm. No evidence of fully excitable cells in the core of vortex was observed.