Departments of Medicine, Biomedical Engineering, and Physiology, University of Alabama at Birmingham; and Department of Internal Medicine, CARMA Center, University of Utah, Salt Lake City.
Circ Arrhythm Electrophysiol. 2013 Dec;6(6):1192-9. doi: 10.1161/CIRCEP.113.000459. Epub 2013 Nov 15.
Previous studies showed that endocardial activation during long-duration ventricular fibrillation (VF) exhibits organized activity. We identified and quantified the different types of organized activity.
Two 64-electrode basket catheters were inserted, respectively, into the left ventricle and right ventricle of dogs to record endocardial activation from the endocardium during 7 minutes of VF (controls, n=6). The study was repeated with the K(ATP) channel opener pinacidil (n=6) and the calcium channel blocker flunarizine (n=6). After 2 minutes of VF without drugs, 2 highly organized left ventricular endocardial activation patterns were observed: (1) ventricular electric synchrony pattern, in which endocardial activation arose focally and either had a propagation sequence similar to sinus rhythm or arose near papillary muscles, and (2) stable pattern, in which activation was regular and repeatable, sometimes forming a stable re-entrant circuit around the left ventricular apex. Between 3 and 7 minutes of VF, the percent of time ventricular electric synchrony was present was control=25%, flunarizine=24% (P=0.44), and pinacidil=0.1% (P<0.001) and the percent of time stable pattern was present was control=71%, flunarizine=48% (P<0.001), and pinacidil=56% (P<0.001). The remainder of the time, nonstable re-entrant activation with little repeatability was present.
After 3 minutes, VF exhibits 2 highly organized endocardial activation patterns 96% of the time, one potentially arising focally in the Purkinje system that was prevented with a K(ATP) channel opener but not a calcium channel blocker and the other potentially arising from a stable re-entrant circuit near the apical left ventricular endocardium.
先前的研究表明，长时间心室颤动（VF）期间的心内膜激活表现出有组织的活动。我们确定并量化了不同类型的有组织活动。
将两个 64 电极篮状导管分别插入犬的左心室和右心室，以在心内膜记录 VF 期间 7 分钟的心内膜激活（对照，n=6）。用 K(ATP)通道开放剂 pinacidil（n=6）和钙通道阻滞剂 flunarizine（n=6）重复该研究。在没有药物的 VF 持续 2 分钟后，观察到 2 种高度有组织的左心室心内膜激活模式：（1）心室电同步模式，其中心内膜激活从焦点处出现，并且具有类似于窦性节律的传播顺序，或者在乳头肌附近出现；（2）稳定模式，其中激活是规则且可重复的，有时在左心室顶点周围形成稳定的折返环。在 VF 的 3 到 7 分钟之间，心室电同步出现的时间百分比在对照为 25%，flunarizine 为 24%（P=0.44），而 pinacidil 为 0.1%（P<0.001），稳定模式出现的时间百分比为对照为 71%，flunarizine 为 48%（P<0.001），而 pinacidil 为 56%（P<0.001）。其余时间，出现了无规律的、可重复性差的折返激活。
在 3 分钟后，VF 96%的时间表现出 2 种高度有组织的心内膜激活模式，一种可能是在浦肯野系统中出现焦点，这可以通过 K(ATP)通道开放剂来预防，但不能通过钙通道阻滞剂来预防，另一种可能是在左心室心尖附近的稳定折返环中出现。
