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. Author manuscript; available in PMC: 2007 Sep 24.
Published in final edited form as: Heart Rhythm. 2006 Jul 7;3(9):1074–1078. doi: 10.1016/j.hrthm.2006.05.030

Figure 4.

Figure 4

Bupivacaine-induced phase 2 reentry. Shown are transmembrane action potentials from 2 epicardial sites (A), or 2 epicardial sites and an M cell site (B), together with a transmural ECG recorded from a canine arterially-perfused right ventricular wedge preparation exposed to 10 uM bupivacaine in the presence of 0.1 uM verapamil. Basic cycle length = 400 msec. A: Propagation of the action potential dome from epicardial sites at which to dome was maintained to sites at which it was lost gives rise to a concealed form of phase 2 re-entry. The concealed phase 2 reentrant beat accentuates the negative T wave, thus giving rise to marked T wave alternans. B: Propagation of the epicardial action potential dome fails in the first grouping but succeeds in the second, giving rise to a phase 2 reentrant beat that activates the entire preparation, thus generating a closely-coupled extrasystole in the ECG. The reentrant beat further accentuates the negative T wave.