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CLINICAL STUDIES

Characteristics of wave fronts during ventricular fibrillation in human hearts with dilated cardiomyopathy: role of increased fibrosis in the generation of reentry

^a Division of Cardiology, Department of Medicine and Department of Pathology, Burns and Allen Research Institute, Cedars-Sinai Medical Center and University of California Los Angeles School of Medicine, Los Angeles, California, USA

Manuscript received September 12, 1997; revised manuscript received March 4, 1998, accepted March 17, 1998.

Address for correspondence: Dr. Peng-Sheng Chen, Division of Cardiology, Room 5342, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, California 90048
chenp{at}csmc.edu

Objectives. We sought to evaluate the characteristics of wave fronts during ventricular fibrillation (VF) in human hearts with dilated cardiomyopathy (DCM) and to determine the role of increased fibrosis in the generation of reentry during VF.

Background. The role of increased fibrosis in reentry formation during human VF is unclear.

Methods. Five hearts from transplant recipients with DCM were supported by Langendorff perfusion and were mapped during VF. A plaque electrode array with 477 bipolar electrodes (1.6-mm resolution) was used for epicardial mapping. In heart no. 5, we also used 440 transmural bipolar recordings. Each mapped area was analyzed histologically.

Results. Fifteen runs of VF (8 s/run) recorded from the epicardium were analyzed, and 55 episodes of reentry were observed. The life span of reentry was short (one to four cycles), and the mean cycle length was 172 ± 24 ms. In heart no. 5, transmural scroll waves were demonstrated. The most common mode of initiation of reentry was epicardial breakthrough, followed by a line of conduction block parallel to the epicardial fiber orientation (34 [62%] of 55 episodes). In the areas with lines of block, histologic examination showed significant fibrosis separating the epicardial muscle fibers and bundles along the longitudinal axis of fiber orientation. The mean percent fibrous tissue in these areas (n = 20) was significantly higher than that in the areas without block (n = 28) (24 ± 7.5% vs. 10 ± 3.8%, p < 0.0001).

Conclusions. In human hearts with DCM, epicardial reentrant wave fronts and transmural scroll waves were present during VF. Increased fibrosis provides a site for conduction block, leading to the continuous generation of reentry.

Abbreviations and Acronyms   DCM = dilated cardiomyopathy   VF = ventricular fibrillation

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