Tabereaux Paul B, Walcott Greg P, Rogers Jack M, Kim Jong, Dosdall Derek J, Robertson Peter G, Killingsworth Cheryl R, Smith William M, Ideker Raymond E
Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA.
Circulation. 2007 Sep 4;116(10):1113-9. doi: 10.1161/CIRCULATIONAHA.107.699264. Epub 2007 Aug 13.
The roles of Purkinje fibers (PFs) and focal wave fronts, if any, in the maintenance of ventricular fibrillation (VF) are unknown. If PFs are involved in VF maintenance, it should be possible to map wave fronts propagating from PFs into the working ventricular myocardium during VF. If wave fronts ever arise focally during VF, it should be possible to map them appearing de novo.
Six canine hearts were isolated, and the left main coronary artery was cannulated and perfused. The left ventricular cavity was exposed, which allowed direct endocardial mapping of the anterior papillary muscle insertion. Nonperfused VF was induced, and 6 segments of data, each 5 seconds long, were analyzed during 10 minutes of VF. During 36 segments of data that were analyzed, 1018 PF or focal wave fronts of activation were identified. In 534 wave fronts, activation was mapped propagating from working ventricular myocardium to PF. In 142 wave fronts, activation was mapped propagating from PF to working ventricular myocardium. In 342 wave fronts, activation was mapped arising focally. More than 1 of these 3 patterns could occur in the same wave front.
PFs are highly active throughout the first 10 minutes of VF. In addition to retrograde propagation from the working ventricular myocardium to PFs, antegrade propagation occurs from PFs to working ventricular myocardium, which suggests PFs are important in VF maintenance. Prior plunge needle recordings in dogs indicate activation propagates from the endocardium toward the epicardium after 1 minute of VF, which suggests that focal sites on the endocardium may represent foci and not breakthrough. If so, in addition to reentry, abnormal automaticity or triggered activity may also occur during VF.
浦肯野纤维（PFs）以及局灶性波前（若存在）在室颤（VF）维持过程中的作用尚不清楚。如果PFs参与室颤维持，那么在室颤期间应该能够绘制从PFs传播到工作心室心肌的波前。如果在室颤期间波前曾局灶性出现，那么应该能够绘制它们的新生情况。
分离出6只犬的心脏，对左主冠状动脉进行插管并灌注。暴露左心室腔，以便对前乳头肌附着处进行直接心内膜标测。诱发非灌注性室颤，并在室颤10分钟期间分析6段数据，每段数据时长5秒。在分析的36段数据中，识别出1018个PF或激活的局灶性波前。在534个波前中，标测到激活从工作心室心肌传播到PF。在142个波前中，标测到激活从PF传播到工作心室心肌。在342个波前中，标测到激活局灶性出现。这三种模式中的一种以上可能出现在同一波前。
在室颤的最初10分钟内，PFs高度活跃。除了从工作心室心肌向PFs的逆行传播外，还存在从PFs向工作心室心肌的顺行传播，这表明PFs在室颤维持中很重要。先前在犬身上进行的针刺记录表明，室颤1分钟后激活从心内膜向心外膜传播，这表明心内膜上的局灶部位可能代表病灶而非突破点。如果是这样，除了折返外，室颤期间还可能发生异常自律性或触发活动。
