Runaway Pacemakers in Ventricular Fibrillation

摘要: Arunaway pacemaker is a malfunctioning that paces the heart at rapid rates. A report from Australia 30 years ago1 described patient with runaway paced ventricles 280 bpm. The survived only because one of coauthors alertly cut wires to disconnect high-frequency focal source myocardium. In this issue Circulation , Thomas et al2 they occasionally detected sustained sources during ventricular fibrillation (VF) in sheep myocardial infarction (MI). Specifically, 3 12 hearts, periodic activations 1.3% intramural electrodes sampled. authors propose these findings support hypothesis3 relatively stable (“mother rotor”), fibrillatory conduction block occurring remainder ventricle, may be mechanism VF model. This mother rotor contrasts multiple wavelet mechanism, which all rotors are unstable and wavebreak engine driving fibrillation. Both mechanisms have been documented various settings,4 but controversy exists over most common clinically relevant diseased human hearts. has therapeutic implications it suggested ablation strategy abolish VF. At same time, just allow next-fastest daughter take its place wavebreaks act as niduses for new rotors. any case, however, even test intriguing strategy, first necessary identify location rotor, elusive date, especially large animals.5 present study, large-animal model, therefore significant. They also raise important questions. …