Organization of myocardial activation during ventricular fibrillation after myocardial infarction - Evidence for sustained high-frequency sources

Background - Studies of ventricular fibrillation (VF) in small mammals have revealed localized sustained stationary reentry. However, studies in large mammals with surface mapping techniques have demonstrated only relatively short-lived rotors. The purpose of this study was to identify whether sustained high-frequency activation with low beat-to-beat variability was present at intramural sites in a postinfarct ovine model of VF. Methods and Results - VF was induced in 12 sheep 77 +/- 40 days after anterior myocardial infarction. Electrical activation was recorded with 20 multielectrode transmural plunge needles. Unipolar electrogram frequency content and local cycle duration variability were studied in 30-second recordings beginning 5 seconds after the onset of VF. Higher mean beat frequency was associated with lower SD of the cycle duration intervals (r = -0.91, P < 0.001). The mean beat frequency and the SD of cycle duration intervals of the highest-frequency electrode were 8.8 +/- 2.0 Hz and 17 +/- 11 ms. In 3 cases, a region with regular activation throughout the recording was identified (SD of the cycle duration interval, 6.0 +/- 0.7 ms). Two of these sites and 67% of all sites with low local cycle duration variability were intramural. They occurred within regions with a high dominant frequency as determined by fast Fourier transform of the unipolar electrogram. Conclusions - Regions with the highest frequency of activation during VF were always associated with a low local cycle duration variability and usually intramural in this chronic infarct model. In a minority of cases, a region of stable, rapid, and very regular activation could be identified. These findings support the hypothesis that relatively stable periodic sources form a component of the mechanism of VF in this model.