MECHANISM OF VENTRICULAR-FIBRILLATION IN MAN - OBSERVATIONS BASED ON ELECTRODE CATHETER RECORDINGS

Observations are reported on the initiation and spontaneous termination of ventricular fibrillation in man using endocardial electrode catheter recordings. The report is based on 16 patients in whom ventricular fibrillation developed during electrophysiologic study. In 11 patients ventricular fibrillation was initiated by programmed ventricular stimulation and in 5 patients ventricular fibrillation occurred spontaneously. In each patient two to five simultaneous ventricular electrograms were recorded at the onset or termination, or both, of ventricular fibrillation. In most patients ventricular fibrillation began as a rapid and accelerating ventricular rhythm in which local electrograms remained discrete and with progressively shortening coupling intervals. Degeneration of local electrograms into fibrillatory activity occurred at random and at varying times. In four patients ventricular fibrillation developed spontaneously during sustained ventricular tachycardia. In these cases there was acceleration of the ventricular tachycardia before degeneration to ventricular fibrillation. Fragmentation and disorganization in local ventricular electrograms did not appear to spread between contiguous areas, but occurred randomly in widely separated areas. In six patients ventricular fibrillation spontaneously converted to sinus rhythm. In four of these cases spontaneous conversion was preceded by sequential reorganization of the electrograms and a tendency toward increasing interelectrographic intervals. These observations are compatible with the multiple wavelet (reentrant) theory of ventricular fibrillation. © 1979.