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A Canine Model of Torsades de Pointes
Author(s) -
LEICHTER DONALD,
DANILO PETER,
BOYDEN PENELOPE,
ROSEN TOVE S.,
ROSEN MICHAEL R.
Publication year - 1988
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1988.tb05990.x
Subject(s) - torsades de pointes , quinidine , medicine , aconitine , qt interval , cardiology , afterdepolarization , prolongation , anesthesia , pharmacology , repolarization , electrophysiology
Although quinidine has been reported to induce QT interval prolongation and torsades de pointes clinically, the only experimental model currently available for quinidine‐induced torsades de pointes requires the concurrent use of ischemia, reperfusion and cardiac pacing of the isolated, perfused heart. Our purpose in this study was to determine the circumstances under which quinidine might elicit torsades de pointes consistently in the intact dog. We found that maintenance of therapeutic plasma quinidine concentrations, alone, did not induce the arrhythmia. Rather, arrhythmia induction required the additional application of aconitine, which induces early afterdepolarizations and triggered activity. When aconitine was applied to two epicardial sites in dogs having quinidine‐induced QT interval prolongation > 10%, torsades de pointes occurred in 80% of instances. When QT prolongation was < 10%, aconitine‐induced torsades de pointes was seen in only 21% of animals. Our results suggest that in a previously healthy heart quinidine‐induced QT prolongation is, itself, insufficient to induce torsades de pointes consistently, and two independent sites of ectopic activity are needed as well. The ectopic foci appear to modulate one another's impulse initiation or activation sequence, thereby giving rise to the classical “twisting of the points” associated with the arrhythmia.