Purkinje and ventricular contributions to endocardial activation sequence in perfused rabbit right ventricle.

ABSTRACT

Interactions between peripheral conduction system and myocardial wave fronts control the ventricular endocardial activation sequence. To assess those interactions during sinus and paced ventricular beats, we recorded unipolar electrograms from 528 electrodes spaced 0.5 mm apart and placed over most of the perfused rabbit right ventricular free wall endocardium. Left ventricular contributions to electrograms were eliminated by cryoablating that tissue. Electrograms were systematically processed to identify fast (P) deflections separated by >2 ms from slow (V) deflections to measure P-V latencies. By using this criterion during sinus mapping (n = 5), we found P deflections in 22% of electrograms. They preceded V deflections at 91% of sites. Peripheral conduction system wave fronts preceded myocardial wave fronts by an overall P-V latency magnitude that measured 6.7 +/- 3.9 ms. During endocardial pacing (n = 8) at 500 ms cycle length, P deflections were identified on 15% of electrodes and preceded V deflections at only 38% of sites, and wave fronts were separated by a P-V latency magnitude of 5.6 +/- 2.3 ms. The findings were independent of apical, basal, or septal drive site. Modest changes in P-V latency accompanied cycle length accommodation to 125-ms pacing (6.8 +/- 2.6 ms), although more pronounced separation between wave fronts followed premature stimulation (11.7 +/- 10.4 ms). These results suggested peripheral conduction system and myocardial wave fronts became functionally more dissociated after premature stimulation. Furthermore, our analysis of the first ectopic beats that followed 12 of 24 premature stimuli revealed comparable separation between wave fronts (10.7 +/- 5.5 ms), suggesting the dissociation observed during the premature cycles persisted during the initiating cycles of the resulting arrhythmias.