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Repolarisation and Arrhythmogenesis

Repolarisation and Arrhythmogenesis

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Delivering (oxygenated) blood to the body is the main task of the heart. For this, the heart has to be excited and the myocytes have to contract synchronously: the process of excitation-contraction.  The ventricular impulse is generated in the sinus node and spreads rapidly (conduction). After contraction the heart has to restore its electrical and contractile parameters (repolarization). Ventricular arrhythmias can be based on 2 arrhythmogenic mechanisms: triggered activity and reentry. Their respective cause is disturbances in repolarization (triggered activity) and/or conduction (reentry).

When the repolarization reserve is decreased, a(n additional) challenge on repolarization may induce afterdepolarizations (triggered activity) that initiate ectopic beats. This process is started by instable prolongation of the ventricular action potential: an increase in beat-to-beat variability of repolarization. This increase can be detected in electrophysiological parameters and by that 1) identify patients at risk or 2) even prevent the arrhythmia from occurring when the parameter is coupled with an intervention algorithm. Perpetuation of the arrhythmia can be (a combination) of reentry and triggered activity. 

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Marc Vos

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