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March 1, 1989Journal of Clinical Investigation388 citationsOpen Access

Stimulus-induced critical point. Mechanism for electrical initiation of reentry in normal canine myocardium.

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Why the study?

Does a premature stimulus interacting with refractory tissue create reentry in normal canine myocardium?

Population

14 dogs (normal right ventricular myocardium)

Design

Preclinical

Key result

Circus reentry occurs around a critical point where an S2 field of approximately 5 V/cm intersects tissue approximately at the end of its refractory period.

Authors

DFDavid W. FrazierPWPatrick D. WolfJWJ. Marcus Wharton

Discussion

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Overview

Informs reentry mechanisms in normal myocardium; leaves open translation to clinical arrhythmias.

Structured PICO

Does a premature stimulus interacting with refractory tissue create reentry in normal canine myocardium?

P
Population
14 dogs (normal right ventricular myocardium)
I
Intervention
Premature (S2) stimulus (cathodal S2 shocks of 25 to 250 V lasting 3 ms) interacting with relatively refractory tissue
O
Outcome
Creation of unidirectional block and reentry (circus reentry)surrogate

Demonstrates that circus reentry can be initiated in normal myocardium when an electrical field intersects tissue at the end of its refractory period, establishing the 'critical point' hypothesis.

Limitations

  • Animal model (canine)
  • Acute open-chest preparation under anesthesia
  • Assumption that transmural component of potential gradient was small for epicardial array calculations

Cite This Study

Frazier et al. (1989) studied Ventricular fibrillation / Reentry (n=14). Premature (S2) electrical stimulus was evaluated on Potential gradient and preshock interval at the center of the reentrant circuit. Circus reentry occurs around a critical point where an S2 field of approximately 5 V/cm intersects tissue approximately at the end of its refractory period.

synapsesocial.com/papers/6a0f8b5cd13714ec96fe4810https://doi.org/10.1172/jci113945
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