Papillary muscle ablation during propranolol infusion terminated ventricular fibrillation in 67% to 100% of rabbit hearts, compared to 0% in control groups (P<0.001).
Does focal ablation of the papillary muscle terminate ventricular fibrillation in rabbit hearts treated with propranolol?
In a rabbit model, propranolol converts multiple-wavelet ventricular fibrillation into a focal source anchored to the papillary muscle, allowing for termination via focal ablation.
Absolute Event Rate: 100% vs 0%
p-value: p=<0.001
BACKGROUND: A therapeutic implication of the focal-source hypothesis of ventricular fibrillation (VF) is that VF can be terminated by focal ablation. We hypothesize that beta-adrenergic receptor blockade converts multiple-wavelet VF to focal-source VF and that this focal source is located near the papillary muscle (PM). METHODS AND RESULTS: We used optical mapping techniques to study the effects of propranolol (0.3 mg/L) on VF dynamics in Langendorff-perfused rabbit hearts. The left ventricular (LV) anterior wall was mapped and optical action potential duration restitution (APDR) was determined at 25 epicardial sites. We performed ablation during VF of the left anterior PM in hearts with (N=6) or without (N=6) cytochalasin infusion, the LV lateral epicardium (Epi group, N=3), and the LV endocardium (Endo group, N=3). The PM was also ablated in 3 hearts without propranolol (control group). Propranolol converted multiple-wavelet VF to slow VF with reentry localized to the PM. Propranolol decreased the maximal slope of the APDR curve (P<0.001) as well as its spatial heterogeneity (P<0.01) and conduction velocity (P=0.01) while increasing the VF cycle length (P<0.001). PM ablation terminated VF during propropranolol infusion with (6 of 6, 100%) or without (4 of 6, 67%) cytochalasin D and significantly reduced inducibility. VF did not terminate in the Epi, Endo, and control groups (P<0.001). CONCLUSIONS: Propranolol flattens the APDR curve and reduces conduction velocity, converting multiple-wavelet VF into VF with a focal source anchored to the PM. Ablation of this focal source may terminate VF.
Pak et al. (Tue,) conducted a other in Ventricular fibrillation (n=21). Papillary muscle ablation during propranolol infusion vs. Epicardial, endocardial, and no-propranolol control groups was evaluated on Termination of ventricular fibrillation (p=<0.001). Papillary muscle ablation during propranolol infusion terminated ventricular fibrillation in 67% to 100% of rabbit hearts, compared to 0% in control groups (P<0.001).