Herre J M, Wetstein L, Lin Y L, Mills A S, Dae M, Thames M D
Department of Medicine, University of California, San Francisco 94143-0214.
J Am Coll Cardiol. 1988 Feb;11(2):414-21. doi: 10.1016/0735-1097(88)90110-6.
Transmural myocardial infarction interrupts sympathetic nerves and denervates viable muscle distal to myocardial infarction. The effect of sympathetic stimulation on responses to programmed ventricular stimulation was studied in dogs without myocardial infarction (Group I: n = 5), with transmural anterior wall myocardial infarction (Group II: n = 6) and with nontransmural anterior wall myocardial infarction (Group III: n = 9). Ventricular effective refractory period during sympathetic stimulation decreased by 16 +/- 18, 1 +/- 2 and 12 +/- 8 ms (mean +/- SD) in viable muscle of the inferoapical left ventricle in Groups I, II and III, respectively, suggesting efferent sympathetic denervation by transmural myocardial infarction only. Sustained ventricular tachycardia or fibrillation was induced more easily during sympathetic stimulation in six of the six dogs with transmural infarction, but in only two of the nine dogs with nontransmural infarction (p less than 0.01). It is concluded that the partial sympathetic denervation produced by transmural myocardial infarction enhances the ease of induction of ventricular tachycardia and fibrillation during sympathetic stimulation. A similar mechanism may lead to increased risk for lethal arrhythmias during periods of high sympathetic tone in patients with transmural myocardial infarction.
透壁性心肌梗死会中断交感神经，使梗死心肌远端的存活心肌去神经支配。在无心肌梗死的犬（I组：n = 5）、有透壁性前壁心肌梗死的犬（II组：n = 6）和有非透壁性前壁心肌梗死的犬（III组：n = 9）中，研究了交感神经刺激对程序性心室刺激反应的影响。在I组、II组和III组中，交感神经刺激期间左心室下尖部存活心肌的心室有效不应期分别缩短了16±18、1±2和12±8毫秒（平均值±标准差），提示仅透壁性心肌梗死导致传出交感神经去神经支配。在6只透壁性梗死犬中，有6只在交感神经刺激期间更容易诱发持续性室性心动过速或心室颤动，但在9只非透壁性梗死犬中只有2只出现这种情况（p<0.01）。结论是，透壁性心肌梗死导致的部分交感神经去神经支配会增加交感神经刺激期间诱发室性心动过速和心室颤动的易感性。类似机制可能导致透壁性心肌梗死患者在交感神经张力增高期间发生致命性心律失常的风险增加。
