Tachysystolic stage
Wiggers described the onset of ventricular fibrillation (VF) as
initiated by a short run of premature contractions which he described as
the tachysystolic stage (TCHS). In all CAD patients, there was a
predominant morphology with right bundle branch and superior axis, which
remind us of the morphology of VTs with origin in posterior papillary
muscle. It is known that the papillary muscle plays a vital role in the
generation and maintenance of reentry during
VF13. It could be hypothesized that in patients
with coronary arterial disease that Wiggers’ tachysystolic stage of VF
is related to the activation of the posterior papillary muscle. It might
also be considered that the activation proceeds from the scar in cases
of inferior posterior infarction; in fact, the rotor has been located at
the edges of the scar14. Favoring the hypothesis of
the origin from the posterior papillary muscle, we have also seen this
morphology in a case with anterior / lateral infarction , as well as in
spontaneous cases of VF in ischemic patients regardless of the location
of the scar location.
In VF cases in patients with Brugada, morphologies compatible with
activation of RVOT predominate and less frequently in the moderating
band. This RVOT morphology has been described
previously15