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Effects of high potassium and the bradycardic agents ZD7288 and cesium on heart rate of rabbits and guinea pigs.

The effects of 2 mM cesium (Cs+) and a novel selective bradycardic agent ZD7288 (0.64 microM) on sinoatrial Node (SAN) pacing rate were investigated in an isolated guinea pig SAN/atrial preparation, rabbit SAN preparation, and isolated working rabbit heart preparation. The effect of Cs+ and ZD7288 on the response of the preparations to increased extracellular potassium concentration ([K+]o) was also studied. Cs+ reduced beating frequency by 24% in isolated rabbit SAN (n = 16, p < 0.01) and by 21% in isolated working rabbit heart (n = 9, p < 0.01). ZD7288 decreased beating rate by 53% in guinea pig SAN (n = 7, p < 0.01) and by 38% in isolated working rabbit heart (n = 6, p < 0.01). In all three preparations, increased [K+]o significantly decreased the rate (p < 0.01) in normal Tyrode's solution but had no effect in the presence of Cs+ and caused tachycardia (p < 0.01) in the presence of ZD7288. We conclude that Cs+ and ZD7288 decrease pacing rate in rabbits and guinea pigs, possibly through modulation of the hyperpolarization-activated current (I(f)). ZD7288 is a more effective bradycardic agent than Cs+.

Animals↗

Elucidating the mechanism of cesium-induced sustained monomorphic ventricular tachycardia in rabbits.

The mechanisms of sustained ventricular tachycardia (VT) induced by large cumulative dose of cesium chloride (Cs) remains unclear. Seven anesthetized rabbits were intravenously injected with Cs (1 mmol/kg) 3 times at 20-min intervals. The surface ECG and monophasic action potential of the left ventricular endocardium were simultaneously recorded. In another 12 rabbits, transmembrane action potentials of right ventricular muscles were recorded with glass microelectrodes. In experiments in vivo, sustained monomorphic VT was induced after the third injection of Cs, whereas the early afterdepolarization (EAD)-related nonsustained polymorphic VT was induced after the second injection. Overdrive pacing during the sustained VT resulted in postdrive acceleration. The pacing and recovery cycle lengths showed an inverse relation. In experiments in vitro, preparations were superfused with Tyrode's solution containing 7.5 mM Cs. Cs initially induced EADs. Additional exposure to Cs depolarized the membrane potential, which consequently attained threshold, producing spontaneous activities. Further exposure resulted in an induction of sustained rhythms that were accelerated by overdrive pacing. Our results indicate that the sustained rhythms at low membrane potential induced by a long exposure to Cs in vitro may underlie an electrophysiologic mechanism for the sustained VT induced after large cumulative dose of Cs in vivo.

Action Potentials↗

Cesium effects on i(f) and i(K) in rabbit sinoatrial node myocytes: implications for SA node automaticity.

Cesium blocks the hyperpolarization-activated current i(f) but blocks neither the delayed-rectifier current i(K) nor the sinoatrial (SA) node discharge. It has been proposed that the failure of Cs+ to block SA discharge is either an incomplete block or a negative shift of i(f). However, an alternative possibility is that i(K) (rather than i(f)) has a predominant role in the SA-pacemaker potential. To investigate this point, the effects of Cs+ on both i(f) and i(K) in the pacemaker range of potentials were studied in the same single SA node cell at the same time by means of the perforated patch-clamp technique. Hyperpolarizing steps from a holding potential (Vh) of -35 mV into and past the pacemaker-potential range resulted in a progressively larger i(f) associated with an increasing slope conductance. Cs+ (2 mM) reversibly blocked both i(f) and the slope conductance increase, suggesting that the current activated was indeed predominantly i(f). Subsequently, hyperpolarizing steps to -50, -60, and -70 mV were applied in the absence (to activate only i(f)) and in the presence of a prior depolarizing step to +10 mV (to activate i(K) as well, as the action potential normally does). Cs+ almost abolished i(f) but only slightly decreased i(K). It is concluded that the failure of Cs+ to block the SA- node spontaneous discharge is not due to a shift of i(f) out of the pacemaker range (due to run-down) or an incomplete block of i(f). Instead, the resistance of i(K) to block by Cs+ is consistent with a predominant role of i(K) for the discharge of the SA node, although i(f) can contribute under normal or special circumstances. The reduction of i(K) by Cs+ raises the question whether the Cs+ slows the SA-node discharge not only by suppressing I(f), but also by reducing i(K).

Action Potentials↗

Chest radiography with a large-area detector based on cesium-iodide/amorphous-silicon technology: image quality and dose requirement in comparison with an asymmetric screen-film system.

The purpose of this study was to evaluate a large-area, flat-panel X-ray detector, which uses cesium-iodide (CsI) and amorphous silicon (a-Si). Conventional images were compared with digital images acquired with equal dose (2.5 microGy) and with 50% dose reduction. Fifteen consecutive patients were studied prospectively using an asymmetric screen-film system (detector dose, 2.5 microGy). Digital images were taken from the same patients in a posteroanterior view with detector doses of 2.5 and 1.25 microGy, respectively. The CsI/a-Si active-matrix imager had a panel-size of 43 x 43 cm, a matrix of 3 x 3k, and a pixel-pitch of 143 microm. Hard copies were presented in a random order to eight independent observers, who rated image quality according to six subjective quality criteria. Statistical significance of differences was evaluated with Student's t test for paired samples (confidence level, 95%). Digital radiographs with 2.5 and 1.25 microGy were superior to conventional images regarding all quality criteria. Statistically significant differences were observed for five of six criteria at a detector dose of 2.5 microGy and for only one quality feature at 1.25 microGy. Flat-panel digital imagers based on CsI/a-Si technique have the potential to replace conventional systems and might allow a reduction of radiation dose by 50% without loss of image quality.

Adult↗

Contrast-detail phantom study for x-ray spectrum optimization regarding chest radiography using a cesium iodide-amorphous silicon flat-panel detector.

RATIONALE AND OBJECTIVES: The purpose of this study evaluating a cesium iodide-amorphous silicon-based flat-panel detector was to optimize the x-ray spectrum for chest radiography combining excellent contrast-detail visibility with reduced patient exposure. MATERIALS AND METHODS: A Lucite plate with 36 drilled holes of varying diameter and depth was used as contrast-detail phantom. For 3 scatter body thicknesses (7.5 cm, 12.5 cm, 21.5 cm Lucite) images were obtained at 113 kVp, 117 kVp, and 125 kVp with additional copper filter of 0.2 and 0.3 mm, respectively. For each setting, radiographs acquired with 125 kVp and no copper filter were taken as standard of reference. On soft-copy displays, 3 observers blinded to the exposure technique evaluated the detectability of each aperture in each image according to a 5-point scale. The number of points given to all 36 holes per image was added. The scores of images acquired with filtration were compared with the standard images by means of a multivariate analysis of variance. Radiation burden was approximated by referring to the entrance dose and calculated using Monte Carlo method. RESULTS: All 6 evaluated x-ray spectra resulted in a statistically equivalent contrast-detail performance when compared with the standard of reference. The combination 125 kVp with 0.3 mm copper was most favorable in terms of dose reduction (approximately 33%). CONCLUSION: Within the constraints of the presented contrast-detail phantom study simulating chest radiography, the CsI/a-Si system enables an addition of up to 0.3 mm copper filtration without the need for compensatory reduction of the tube voltage for providing constant image quality. Beam filtration reduces radiation burden by about 33%.

Cesium↗

Cesium toxicity in Arabidopsis.

Cesium (Cs) is chemically similar to potassium (K). However, although K is an essential element, Cs is toxic to plants. Two contrasting hypotheses to explain Cs toxicity have been proposed: (1) extracellular Cs+ prevents K+ uptake and, thereby, induces K starvation; and (2) intracellular Cs+ interacts with vital K(+)-binding sites in proteins, either competitively or noncompetitively, impairing their activities. We tested these hypotheses with Arabidopsis (Arabidopsis thaliana). Increasing the Cs concentration in the agar ([Cs](agar)) on which Arabidopsis were grown reduced shoot growth. Increasing the K concentration in the agar ([K](agar)) increased the [Cs](agar) at which Cs toxicity was observed. However, although increasing [Cs](agar) reduced shoot K concentration ([K](shoot)), the decrease in shoot growth appeared unrelated to [K](shoot) per se. Furthermore, the changes in gene expression in Cs-intoxicated plants differed from those of K-starved plants, suggesting that Cs intoxication was not perceived genetically solely as K starvation. In addition to reducing [K](shoot), increasing [Cs](agar) also increased shoot Cs concentration ([Cs](shoot)), but shoot growth appeared unrelated to [Cs](shoot) per se. The relationship between shoot growth and [Cs](shoot)/[K](shoot) suggested that, at a nontoxic [Cs](shoot), growth was determined by [K](shoot) but that the growth of Cs-intoxicated plants was related to the [Cs](shoot)/[K](shoot) quotient. This is consistent with Cs intoxication resulting from competition between K+ and Cs+ for K(+)-binding sites on essential proteins.

Arabidopsis↗

Cesium potentiates epileptiform activities induced by bicuculline methiodide in rat neocortex maintained in vitro.

We report that extracellular application of cesium (Cs+, 3 mM) potentiated the epileptiform discharge evoked by GABAA-receptor antagonist bicuculline methiodide (BMI 50 microM) in rat neocortical slices maintained in vitro. Cs+ changed BMI-induced epileptiform burst of a few hundred milliseconds evoked by extracellular focal stimuli into epileptiform discharge only a few seconds long (1.8-7 s). Moreover, Cs+ induced the appearance of spontaneously occurring epileptiform activities (0.038-0.15 Hz). Simultaneous intracellular/extracellular recordings indicated that each intracellular epileptiform burst was correlated with a field discharge. Variation of the membrane potential modified only the amplitude of the epileptiform burst and did not alter its frequency of occurrence, indicating that each discharge was a synchronous population event. The epileptiform discharges were not blocked by the N-methyl-D-aspartate (NMDA) receptor antagonist 3-((+-)-2-carboxypiperazin-4-yl)-propyl-1-phosphonic acid (CPP 5-10 microM). In contrast, the non-NMDA receptor antagonist 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX 0.5-5 microM) greatly reduced the duration of each epileptiform discharge by abolishing its afterdischarges in a concentration-dependent manner. This reduction in duration was accompanied by an increase in frequency of occurrence, however. After blockade of non-NMDA receptors with CNQX, a CPP-sensitive spontaneous discharge could be observed. These findings indicate that the inorganic cation Cs+ applied extracellularly can induce spontaneously occurring epileptiform activities in BMI-treated neocortical slices. In addition, receptors of excitatory amino acids play a major role in synchronizing this type of Cs+/BMI-induced spontaneous epileptiform activities.

6-Cyano-7-nitroquinoxaline-2,3-dione↗

Cesium-induced atrial tachycardia degenerating into atrial fibrillation in dogs: atrial torsades de pointes?

INTRODUCTION: In this study, we investigated whether the potassium channel blocker, cesium chloride (CsCl), which is capable of producing early after-depolarizations (EADs) and polymorphic ventricular tachyarrhythmias resembling torsades de pointes, might exert similar effects in the atria. METHODS AND RESULTS: In nine anesthetized open chest dogs, 5 mL of CsCl in incremental doses (0.05, 0.1, 0.15, 0.2, 0.25 mM/mL) was injected into the sinus node artery to induce atrial arrhythmias. A polymorphic atrial tachycardia (P-AT) apparently triggered by an EAD and degenerating into atrial fibrillation resulted after CsCl administration in six dogs, but not in the remaining three dogs at any dose of CsCl. The P-AT developed during a normal atrial rate (110+/-13.5 beats/min) on six occasions and during atrial bradycardia (58.6+/-17.9 beat/min) five times. P-AT that occurred during a normal atrial rate had the last normal P wave temporally closely related to ventricular activation, with a VA interval of almost zero (1.3+/-3.3 msec), whereas P-AT induced from an atrial bradycardia had no relation to ventricular activation. The %EAD in the atrial bradycardia group (13.9+/-2.5) exceeded that in the normal atrial rate group (10.9+/-1.8) (P < 0.05). CONCLUSION: CsCl induces atrial EADs that provoke P-AT that degenerates into atrial fibrillation. P-AT has some characteristics similar to ventricular torsades de pointes.

Animals↗

Evaluation of the new cesium-131 seed for use in low-energy x-ray brachytherapy.

Characterization measurements and calculations were performed on a new medical seed developed by IsoRay Inc. in Richland, Washington, that utilizes the short-lived isotope 131Cs. This model has recently received FDA 510(k) clearance. The objective of this work was to characterize the dosimetric properties of the new seed according to the AAPM Task Group 43 recommendations. Cesium-131 is a low-energy x-ray emitter, with the most prominent peaks in the 29 keV to 34 keV region. The intended application is brachytherapy for treating cancers in prostate, breast, head and neck, lung, and pancreas. The evaluations performed included air-kerma strength, radial dose function, anisotropy in phantom, half-life, energy spectra, and internal activity. The results indicate the CS-1 seeds have a dose-rate constant of 0.915 cGy hr(-1) U(-1) in water, dose penetration characteristics similar to 125I and 103Pd, anisotropy function values on the order of 0.71 at short distances and small angles, and an average anisotropy factor of 0.964. The overall dosimetric characteristics are similar to 125I and 103Pd seeds with the exception of half-life, which is 9.7 days, as compared to 17 days for 103Pd and 60 days for 125I. The shorter half-life may offer significant advantages in biological effectiveness.

Air↗

X-ray imaging performance of structured cesium iodide scintillators.

Columnar structured cesium iodide (CsI) scintillators doped with Thallium (Tl) have been used extensively for indirect x-ray imaging detectors. The purpose of this paper is to develop a methodology for systematic investigation of the inherent imaging performance of CsI as a function of thickness and design type. The results will facilitate the optimization of CsI layer design for different x-ray imaging applications, and allow validation of physical models developed for the light channeling process in columnar CsI layers. CsI samples of different types and thicknesses were obtained from the same manufacturer. They were optimized either for light output (HL) or image resolution (HR), and the thickness ranged between 150 and 600 microns. During experimental measurements, the CsI samples were placed in direct contact with a high resolution CMOS optical sensor with a pixel pitch of 48 microns. The modulation transfer function (MTF), noise power spectrum (NPS), and detective quantum efficiency (DQE) of the detector with different CsI configurations were measured experimentally. The aperture function of the CMOS sensor was determined separately in order to estimate the MTF of CsI alone. We also measured the pulse height distribution of the light output from both the HL and HR CsI at different x-ray energies, from which the x-ray quantum efficiency, Swank factor and x-ray conversion gain were determined. Our results showed that the MTF at 5 cycles/mm for the HR type was 50% higher than for the HL. However, the HR layer produces approximately 36% less light output. The Swank factor below K-edge was 0.91 and 0.93 for the HR and HL types, respectively, thus their DQE(0) were essentially identical. The presampling MTF decreased as a function of thickness L. The universal MTF, i.e., MTF plotted as a function of the product of spatial frequency f and CsI thickness L, increased as a function of L. This indicates that the light channeling process in CsI improved the MTF of thicker layers more significantly than for the thinner ones.

Algorithms↗

A miniature cesium iodide-photodiode detector for ambulatory monitoring of left ventricular function.

The physical characteristics of a portable nonimaging scintillation probe system for continuous ambulatory monitoring of the left ventricular function are described. The detector of the equilibrium radionuclide labeled blood pool is a single cesium iodide (CsI) crystal coupled to a silicium photodiode and interfaced to a microcomputer. The spatial properties of this small CsI crystal (1 x 1 x 1 cm3) were evaluated with various single-hole collimators. Linearity was studied in nonattenuating medium. Saturation began at 3000 cps, count loss was 10% at 4000 cps, maximal count rate was 24,000 cps. In attenuating medium, isocount curve of 5% of the maximal count rate was 100 mm deep and 160 mm wide. The most appropriate tested lead collimator to record the global ejection fraction of the left ventricle was a disc-shaped (thickness 5 mm, diameter 41 mm) single-hole (proximal aperture 8 mm, distal aperture 18 mm) collimator. Sensitivity was similar to the sensitivity of a sodium iodide nuclear probe. The detection performance appeared comparable to other available detector systems. Our results indicate that such a CsI-photodiode probe is a promising candidate for left ventricular function monitoring. The application to an ambulatory multicrystal detector system is presented and discussed.

Biophysical Phenomena↗

The gramicidin pore: crystal structure of a cesium complex.

Gramicidin, a linear polypeptide composed of hydrophobic amino acids with alternating L- and D- configurations, forms transmembrane ion channels. The crystal structure of a gramicidin-cesium complex has been determined at 2.0 angstrom resolution. In this structure, gramicidin forms a 26 angstrom long tube comprised of two polypeptide chains arranged as antiparallel beta strands that are wrapped into a left-handed helical coil with 6.4 residues per turn. The polypeptide backbone forms the interior of the hydrophilic, solvent-filled pore and the side chains form a hydrophobic and relatively regular surface on the outside of the pore. This example of a crystal structure of a solvent-filled ion pore provides a basis for understanding the physical nature of ion translocation.

Binding Sites↗

Separation of DNA sequences complementary to the RNA of avian myeloblastosis virus from chicken DNA by alkaline cesium chloride density sedimentation.

Density gradient sedimentation in alkaline cesium chloride of DNA from normal chicken embryos or leukemic myeloblasts fragmented to a size of 13S revealed that the DNA sequences complementary to 70S avian myeloblastosis virus RNA sedimented in the high guanine plus cytosine region ahead of the main peak of cellular DNA. When the DNA was fragmented into pieces of 6.6S there was a broader distribution of the DNA sequences complementary to the viral RNA. This technique could be employed as a step towards the isolation of DNA copies of the entire viral RNA genome from the mass of host cellular DNA.

Animals↗

Influence of altered plasma membrane fatty acid composition on cesium transport characteristics and toxicity in Saccharomyces cerevisiae.

The influence of altered plasma membrane fatty acid composition on cesium uptake and toxicity was investigated in Saccharomyces cerevisiae. Detailed kinetic studies revealed that both the Vmax and Km values for Cs+ transport increased (by approximately twofold in the latter case) when S. cerevisiae was grown in medium supplemented with the polyunsaturated fatty acid linoleate. In addition, Cs+ uptake by linoleate-enriched cells was considerably less sensitive to the competitive effects of other monovalent cations (K+, Rb+, and NH4+) than that by unsupplemented cells. Stimulation of Cs+ uptake in the presence of certain K+ and Rb+ concentrations was only evident in linoleate-enriched S. cerevisiae. At 100 mM CsCl, the initial rate of Cs+ uptake was greater in linoleate-supplemented cells than in unsupplemented cells and this was reflected in a more rapid displacement of cellular K+. However, little difference in net Cs+ accumulation between linoleate-supplemented and unsupplemented cells was evident during prolonged incubation in buffer or during growth. Thus, Cs+ toxicity was similar in linoleate-supplemented and unsupplemented cells. The results were consistent with the Cs+ (K+) transport mechanism adopting an altered conformational state in linoleate-enriched S. cerevisiae.

Biological Transport↗

Effects of cesium on spontaneous rate in right atria isolated from diabetic rats.

Previous studies have shown that streptozotocin (STZ) induced diabetes in rats is associated with a decrease in the spontaneous rate of isolated right atria. Present experiments were designed to determine whether this model of insulin-dependent diabetes mellitus alters the chronotropic actions of cesium (Cs+). Right atrial preparations were isolated from STZ-treated and diluent-treated control rats, and bathed in Krebs-Henseleit buffer at 37 degrees C; dose-dependent (0.2-10 mM) effects of Cs+ were examined by cumulative addition. Preparations isolated from diabetic rats had a slower beating rate before exposure to Cs+, and the negative chronotropic response to this cation was diminished in these tissues. In fact, at concentrations between 2 and 10 mM Cs+, spontaneous rate did not differ between the diabetic and control groups. These data suggest that the hyperpolarization-activated current, I(f), may play a role in the slower spontaneous pacemaker rate observed in right atria isolated from STZ-induced diabetic rats.

Animals↗

Chest radiography: optimization of X-ray spectrum for cesium iodide-amorphous silicon flat-panel detector.

PURPOSE: To ascertain the optimum x-ray spectrum for chest radiography with a cesium iodide-amorphous silicon flat-panel detector. MATERIALS AND METHODS: End points for optimization included the ratio of tissue contrast to bone contrast and a figure of merit (FOM) equal to the square of the signal-to-noise ratio of tissue divided by incident exposure to the patient. Studies were conducted with both computer spectrum modeling and experimental measurement in narrow-beam and full-field exposure conditions for four tissue thicknesses (8-32 cm). Three parameters that affect spectra were considered: the atomic number (Z) of filter material (Z = 13, 26, 29, 42, 50, 56, 64, 74, and 82), kilovoltage (from 50 to 150 kVp), and filter thickness (from 0.25 to 2.00 half-value layer [HVL]). RESULTS: Computer modeling and narrow-beam experimental data showed similar trends for the full range of parameters evaluated. Spectrum model results showed that copper filtration at 120 kVp or more was optimum for FOM. The ratio of contrasts showed a trend to be higher with higher kilovoltage and only a minor variation with filter material. Full-field experimental results, which reflect the added contribution of x-ray scatter, differed in magnitude but not trends from the narrow-beam data in all cases except the ratio of contrasts in the mediastinum. CONCLUSION: The best performance overall, including both FOM and ratio of contrasts, was at 120 kVp with 1-HVL copper filtration (0.2 mm). With this beam spectrum and an increase in tube output (ie, milliampere seconds) of about 50%, a chest radiograph can be obtained with image quality approximately equal to that with a conventional spectrum but with about 25% less patient exposure.

Cesium↗

Cesium chloride-induced long QT syndrome: demonstration of afterdepolarizations and triggered activity in vivo.

The identification of afterdepolarizations and their relationship to arrhythmias in vivo is not available. Experiments were undertaken to determine whether afterdepolarizations could be detected in monophasic action potentials (MAPs) recorded in vivo and whether they were related to arrhythmias in an intact canine preparation of the long QT syndrome. Isolated cardiac tissues from six dogs were studied to validate the technique. In simultaneous MAP and transmembrane recordings, afterdepolarizations induced with barium (early) or acetylstrophanthidin (delayed) were detected in MAPs when present in microelectrode recordings. MAPs were then recorded in situ in eight dogs with cesium chloride-induced long QT syndrome associated with ventricular arrhythmias. Afterdepolarizations were identified in each of the dogs and were similar to early afterdepolarizations identified in vitro; they occurred during phase 3 and were attenuated during overdrive pacing. The afterdepolarizations were closely related to arrhythmias: (1) afterdepolarizations always preceded ventricular arrhythmias, (2) the coupling intervals (CI) of the afterdepolarizations (AD) and the ventricular premature beats (VPB) were nearly identical (VPB CI = 1.06 AD CI -10.24; r2 = .87), (3) the take-off potentials of the ventricular premature beats were nearly identical to the amplitude of the afterdepolarizations (take-off potential = 0.98 afterdepolarization amplitude +0.46, r2 = .87), and (4) afterdepolarizations and ventricular arrhythmias resolved concurrently during overdrive pacing and with time. Thus, a new catheter technique has been validated and has been used to directly identify afterdepolarizations and triggered activity in vivo.

Action Potentials↗

Effects of vagal stimulation on cesium-induced early afterdepolarizations and ventricular arrhythmias in rabbits.

BACKGROUND: Previous evidence has shown that increased sympathetic tone enhances the cesium chloride (Cs)-induced early afterdepolarizations (EADs) and ventricular tachycardias (VTs). METHODS AND RESULTS: We assessed the effects of vagal stimulation on Cs-induced EADs and ventricular arrhythmias in the rabbit heart. Monophasic action potentials (MAPs) of the left ventricular endocardium were recorded simultaneously with surface ECG. Two protocols were used: 1) While in their intrinsic sinus rhythm, 11 rabbits were given three intravenous Cs injections (1 mM/kg) 20 minutes apart, and the effects of vagal stimulation on the ventricular arrhythmias thus induced were examined. 2) Under constant atrial pacing (cycle length, 250 msec), EAD amplitude was measured after Cs injection (1 mM/kg) without (five rabbits, control group) or with (four rabbits, vagal stimulation group) vagal stimulation. We observed the following. 1) Cs produced EADs and VTs of polymorphic (PVT) and monomorphic (MVT) types. During PVT, the take-off potential of repetitive premature action potentials in MAP recordings was about the same as the peak level of EADs, and during MVT, the take-off potential was the level of full repolarization. Vagal stimulation suppressed PVT but not MVT. Vagal stimulation after spontaneous termination of MVT restarted MVT of the same morphology at a rate much slower than the preceding sinus rate. 2) EAD amplitude was significantly smaller in the vagal stimulation group than in the control group. CONCLUSIONS: The results suggest that PVT originated from triggering by EADs, whereas MVT was of different origin, and that vagal stimulation suppressed PVT by decreasing the amplitude of EADs.

Action Potentials↗