Delayed afterdepolarizations elicited in vivo by left stellate ganglion stimulation

Activation of cardiac sympathetic nerves is recognized as a triggering factor for cardiac arrhythmias. However, the mechanisms involved have only been speculated. Because evidence from studies in vitro has established a relation between catecholamines, delayed afterdepolarizations (DAD), and triggered rhythms, it seemed possible that in vivo adrenergic activation also might lead to the development of DAD. Because very little evidence was available for DAD in vivo, we have evaluated whether monophasic action potential (MAP) recording with a contact electrode could be a suitable technique for the detection of DAD from the endocardium of anesthetized cats. In six animals, atrial pacing and graded aortic constriction were performed during MAP recording to assess MAP stability during hemodynamic changes, and in no cases were modifications of the baseline observed. In 11 cats, calcium gluconate (0.5 g) and G-strophanthin (100 μg) were administered). Action potential duration at 50% (APD₅₀) and 90% (APD₉₀) repolarization were reduced (from 138 ± 16 to 122 ± 18 msec, p <0.02, and from 163 ± 23 to 149 ± 20 msec, p <0.025, respectively). In eight of 11 (73%) animals, DAD were elicited with a mean amplitude of 1.2 ± 0.4 mV. In 14 cats, the left stellate ganglion was stimulated for 45 seconds. APD₅₀ and APD₉₀ decreased (from 153 ± 15 to 145 ± 16 msec, p <0.005, and from 176 ± 18 to 165 ± 13 msec, p <0.001, respectively). DAD were induced in 10 of 14 animals (71%) with a mean amplitude of 1.2 ± 0.3 mV. These results show that DAD can be induced in vivo by administration of calcium and digitals and by activation of the cardiac sympathetic nerves. This latter finding further strengthens the existing link between adrenergic activation and ventricular arrhythmogenesis and suggests triggered activity as a likely mechanism.