Arad M, Rogel S, Mahler Y, Uretzky G
Joseph Lunenfeld Cardiac Surgery Research Center, Department of Medical Engineering, Hadassah University Hospital, Jerusalem, Israel.
Basic Res Cardiol. 1988 Nov-Dec;83(6):678-86. doi: 10.1007/BF01906963.
Ventricular fibrillation (VF) which is normally sustained in large animals and humans, is transient in small animals. The purpose of the present study was to evaluate the possible effect of changing cardiac rate on spontaneous ventricular defibrillation. In isolated perfused rat heart, VF was electrically induced during normal spontaneous rhythm of the heart at normal rate and at various ventricular pacing rates. It was found that: 1) Electrically induced VF in isolated perfused, non-ischemic rat heart spontaneously terminated in 88% of the hearts; 2) Ventricular pacing rhythm of spontaneous rate plus 10% caused VF to be sustained in 26% of the hearts (which defibrillated spontaneously during normal rates); 3) Ventricular pacing at 200% of the basic rate led to sustained VF in about half the VF episodes (14 out of 33, p less than 0.005). In the remainder, which defibrillated spontaneously, a sustained VF could be achieved by further increase in ventricular pacing rate; 4) Slow pacing rate, as a result of the surgical production of atrioventricular (A-V) block, enhanced the probability of spontaneous defibrillation (21 of 21 episodes after slow pacing vs 24 of 34 episodes following pacing at previous normal sinus rhythm, p less than 0.05). Selective modulation of conduction velocity, refractory period or both, achieved by changes in ventricular pacing rate was assumed to play an important role in determining whether electrically-induced VF would be transient or sustained.
室颤在大型动物和人类中通常是持续性的,而在小型动物中则是短暂性的。本研究的目的是评估心率变化对自发性心室除颤的可能影响。在离体灌注大鼠心脏中,在心脏正常自发节律、正常心率以及不同心室起搏心率下电诱导室颤。结果发现:1)在离体灌注、非缺血的大鼠心脏中,电诱导的室颤在88%的心脏中会自发终止;2)自发性心率加10%的心室起搏节律导致26%的心脏室颤持续(这些心脏在正常心率时会自发除颤);3)以基础心率的200%进行心室起搏,约一半的室颤发作会导致室颤持续(33次发作中有14次,p<0.005)。在其余自发除颤的心脏中,进一步提高心室起搏心率可实现室颤持续;4)由于手术造成房室传导阻滞导致的缓慢起搏心率增加了自发除颤的可能性(缓慢起搏后21次发作中有21次,而在先前正常窦性心律起搏后34次发作中有24次,p<0.05)。通过改变心室起搏心率实现的传导速度、不应期或两者的选择性调节,被认为在决定电诱导的室颤是短暂性还是持续性方面起着重要作用。