Li Li, Zheng Xiangsheng, Dosdall Derek J, Huang Jian, Ideker Raymond E
CARMA Center, Division of Cardiology, University of Utah School of Medicine, Salt Lake City, UT 35294-0019, USA.
J Electrocardiol. 2012 Nov-Dec;45(6):658-9. doi: 10.1016/j.jelectrocard.2012.08.009. Epub 2012 Sep 27.
We tested the hypothesis that after 2 minutes of ventricular fibrillation (VF), periods of highly organized activations occur on the endocardium, arising from an intramural mother rotor or triggered activity originating in the Purkinje fibers. In 6 anesthetized dogs, we recorded electrically induced VF from two-thirds of the endocardium with a 64-electrode basket catheter. In another 12 dogs, the study was repeated with the addition of the early afterdepolarization blocker pinacidil in 6 animals and the delayed afterdepolarization blocker flunarizine in the other 6 animals. We found that, in addition to periods of disorganized chaotic activation (type I pattern), at between 3 and 7 minutes of VF, 2 highly organized patterns were observed (type II pattern, regular activity and type III pattern, triggered activity). When present, these patterns were observed in all 64 electrodes simultaneously. Type II arises from the apex and may be an intramural mother rotor and type III arises focally in Purkinje fibers and may be caused by early afterdepolarizations. The optimal defibrillation strategy may be different for the 3 different VF patterns. Therefore, it is important to determine if these 3 patterns can be differentiated from the body surface electrocardiogram.
在心室颤动（VF）持续2分钟后，心内膜上会出现高度有序的激活期，这是由壁内母转子或起源于浦肯野纤维的触发活动引起的。在6只麻醉犬中，我们用64电极篮状导管从三分之二的心内膜记录电诱导的VF。在另外12只犬中，重复该研究，其中6只动物添加早期后去极化阻滞剂吡那地尔，另外6只动物添加延迟后去极化阻滞剂氟桂利嗪。我们发现，除了无序的混沌激活期（I型模式）外，在VF持续3至7分钟时，还观察到2种高度有序的模式（II型模式，规则活动；III型模式，触发活动）。当这些模式出现时，在所有64个电极上同时观察到。II型模式起源于心尖，可能是壁内母转子，III型模式在浦肯野纤维中局灶性出现，可能由早期后去极化引起。对于这3种不同的VF模式，最佳除颤策略可能不同。因此，确定这3种模式是否能从体表心电图中区分出来很重要。
