Severe Bradycardia Increases the Incidence and Severity of Torsade de Pointes Arrhythmias by Augmenting Preexistent Spatial Dispersion of Repolarization in the CAVB Dog Model.

Valerie Y H Van Weperen,Marcel A G Van Der Heyden,Jacques M T De Bakker,Jet D M Beekman,Marc A Vos,Alexandre Bossu,Rosanne Varkevisser,Albert Dunnink,Veronique M F Meijborg,Ruben Coronel

doi:10.3389/fphys.2021.642083

Abstract

IntroductionTorsade de pointes arrhythmias (TdP) in the chronic atrioventricular block (CAVB) dog model result from proarrhythmic factors, which trigger TdP and/or reinforce the arrhythmic substrate. This study investigated electrophysiological and arrhythmogenic consequences of severe bradycardia for TdP.MethodsDofetilide (25 μg/kg per 5 min) was administered to eight anesthetized, idioventricular rhythm (IVR) remodeled CAVB dogs in two serial experiments: once under 60 beats per minute (bpm), right ventricular apex paced (RVA60) conditions, once under more bradycardic IVR conditions. Recordings included surface electrocardiogram and short-term variability (STV) of repolarization from endocardial unipolar electrograms. TdP inducibility (three or more episodes within 10 min after start of dofetilide) and arrhythmic activity scores (AS) were established. Mapping experiments in 10 additional dogs determined the effect of lowering rate on STV and spatial dispersion of repolarization (SDR) in baseline.ResultsIVR-tested animals had longer baseline RR-interval (1,403 ± 271 ms) and repolarization intervals than RVA60 animals. Dofetilide increased STV similarly under both rhythm strategies. Nevertheless, TdP inducibility and AS were higher under IVR conditions (6/8 and 37 ± 27 vs. 1/8 and 8 ± 12 in RVA60, respectively, both p < 0.05). Mapping: Pacing from high (128 ± 10 bpm) to middle (88 ± 10 bpm) to experimental rate (61 ± 3 bpm) increased all electrophysiological parameters, including interventricular dispersion, due to steeper left ventricular restitution curves, and intraventricular SDR: maximal cubic dispersion from 60 ± 14 (high) to 69 ± 17 (middle) to 84 ± 22 ms (p < 0.05 vs. high and middle rate).ConclusionIn CAVB dogs, severe bradycardia increases the probability and severity of arrhythmic events by heterogeneously causing electrophysiological instability, which is mainly reflected in an increased spatial, and to a lesser extent temporal, dispersion of repolarization.

Highlights

Torsade de pointes arrhythmias (TdP) in the chronic atrioventricular block (CAVB) dog model result from proarrhythmic factors, which trigger TdP and/or reinforce the arrhythmic substrate
The two main characteristics of the CAVB dog—the compensated heart failure combined with its increased susceptibility for TdP— which both result from ventricular remodeling, make this animal model unique in the research field of ventricular arrhythmias
Cardiac remodeling that results in compensated heart failure is associated with an increased risk of sudden cardiac death (SCD) as the result of ventricular arrhythmias

Summary

Introduction

Torsade de pointes arrhythmias (TdP) in the chronic atrioventricular block (CAVB) dog model result from proarrhythmic factors, which trigger TdP and/or reinforce the arrhythmic substrate. The employment of the chronic atrioventricular block (CAVB) dog model has resulted in great advances in the research field of ventricular arrhythmias. The reproducibility of torsade de pointes arrhythmias (TdP) in this model results from complex ventricular adaptation processes, initiated by ablation of the proximal His bundle. The subsequent chronic drop in heart rate and cardiac output, combined with an altered ventricular activation pattern, initiate contractile, structural, and electrical remodeling processes. These adaptations reestablish an adequate cardiac output but simultaneously, and adversely, increase susceptibility for TdP (Oros et al, 2008; Dunnink et al, 2012)

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