Bidirectional ventricular tachycardia: ping pong in the His-Purkinje system.


BACKGROUND:Bidirectional ventricular tachycardia (BVT), which is characterized by an alternating beat-to-beat ECG QRS axis, is a rare but intriguing arrhythmia associated with digitalis toxicity, familial catecholaminergic polymorphic ventricular tachycardia (CPVT), and several other conditions that predispose cardiac myocytes to delayed afterdepolarizations (DADs) and triggered activity. Evidence from human and animal studies attributes BVT to alternating ectopic foci originating from the distal His-Purkinje system in the left and/or right ventricle, respectively. OBJECTIVE:The purpose of this study was to evaluate a simple "ping pong" model of reciprocating bigeminy to explain BVT. METHODS:We constructed a two-dimensional anatomic model of the rabbit ventricles with a simplified His-Purkinje system, in which different sites in the His-Purkinje system had different heart rate thresholds for DAD-induced bigeminy. RESULTS:When the heart rate exceeded the threshold for bigeminy at the first site in the His-Purkinje system, ventricular bigeminy developed, causing the heart rate to accelerate and exceed the threshold for bigeminy at the second site. Thus, the triggered beat from the first site induced a triggered beat from the second site. The triggered beat from the second site next reciprocated by inducing a triggered beat from the first site, and so forth. Bigeminy from two sites produced BVT, and that from three or more sites produced polymorphic VT. CONCLUSION:This "ping pong" mechanism of reciprocating bigeminy readily produces the characteristic ECG pattern of BVT and its degeneration to polymorphic VT if additional sites develop bigeminy.


Heart Rhythm


Heart rhythm


Baher AA,Uy M,Xie F,Garfinkel A,Qu Z,Weiss JN




Has Abstract


2011-04-01 00:00:00














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    journal_title:Heart rhythm

    pub_type: 杂志文章


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    更新日期:2016-11-01 00:00:00

  • Clinical predictors and relationship between early and late atrial tachyarrhythmias after pulmonary vein antrum isolation.

    abstract:BACKGROUND:Several studies have reported early (EAT) and late (LAT) atrial tachyarrhythmias following atrial fibrillation (AF) ablation, but the factors associated with them and their clinical significance are not well known. OBJECTIVE:The purpose of this study was to investigate the predictors and the relationship be...

    journal_title:Heart rhythm

    pub_type: 杂志文章


    authors: Themistoclakis S,Schweikert RA,Saliba WI,Bonso A,Rossillo A,Bader G,Wazni O,Burkhardt DJ,Raviele A,Natale A

    更新日期:2008-05-01 00:00:00

  • A novel radiofrequency ablation catheter using contact force sensing: Toccata study.

    abstract:OBJECTIVES:The aim of this multicenter study was to evaluate the device- and procedure-related safety of a novel force-sensing radiofrequency (RF) ablation catheter capable of measuring the real-time contact force (CF) and to present CF data and its possible implications on patient safety. BACKGROUND:The clinical outc...

    journal_title:Heart rhythm

    pub_type: 杂志文章,多中心研究


    authors: Kuck KH,Reddy VY,Schmidt B,Natale A,Neuzil P,Saoudi N,Kautzner J,Herrera C,Hindricks G,Jaïs P,Nakagawa H,Lambert H,Shah DC

    更新日期:2012-01-01 00:00:00

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    journal_title:Heart rhythm

    pub_type: 杂志文章


    authors: Hussein AA,Martin DO,Saliba W,Patel D,Karim S,Batal O,Banna M,Williams-Andrews M,Sherman M,Kanj M,Bhargava M,Dresing T,Callahan T,Tchou P,Di Biase L,Beheiry S,Lindsay B,Natale A,Wazni O

    更新日期:2009-10-01 00:00:00

  • Adaptive servo-ventilation reduces atrial fibrillation burden in patients with heart failure and sleep apnea.

    abstract:BACKGROUND:Patients with heart failure and sleep apnea are at increased risk for developing arrhythmias. Whether treatment of sleep apnea reduces arrhythmias is unknown. OBJECTIVE:The purpose of this study was to determine whether adaptive servo-ventilation (ASV) with optimal medical therapy (OMT) reduces atrial fibri...

    journal_title:Heart rhythm

    pub_type: 杂志文章,多中心研究,随机对照试验


    authors: Piccini JP,Pokorney SD,Anstrom KJ,Oldenburg O,Punjabi NM,Fiuzat M,Tasissa G,Whellan DJ,Lindenfeld J,Benjafield A,Woehrle H,Blase A,O'Connor CM

    更新日期:2019-01-01 00:00:00

  • Epicardial left atrial appendage and biatrial appendage accessory pathways.

    abstract:BACKGROUND:Acute success rates of accessory pathway ablation for Wolff-Parkinson-White (WPW) syndrome can exceed 95%, with rare failures attributed to anatomically complex epicardial connections. Right atrial appendage to right ventricle pathways have been reported, but their left-sided counterparts have only recently ...

    journal_title:Heart rhythm

    pub_type: 杂志文章


    authors: Mah D,Miyake C,Clegg R,Collins KK,Cecchin F,Triedman JK,Mayer J,Walsh EP

    更新日期:2010-12-01 00:00:00

  • Fractionation of electrograms is caused by colocalized conduction block and connexin disorganization in the absence of fibrosis as AF becomes persistent in the goat model.

    abstract:BACKGROUND:Electrogram fractionation and atrial fibrosis are both thought to be pathophysiological hallmarks of evolving persistence of atrial fibrillation (AF), but recent studies in humans have shown that they do not colocalize. The interrelationship and relative roles of fractionation and fibrotic change in AF persi...

    journal_title:Heart rhythm

    pub_type: 杂志文章


    authors: Kirubakaran S,Chowdhury RA,Hall MC,Patel PM,Garratt CJ,Peters NS

    更新日期:2015-02-01 00:00:00