Surawicz B
J Am Coll Cardiol. 1985 Jun;5(6 Suppl):43B-54B. doi: 10.1016/s0735-1097(85)80526-x.
Ventricular fibrillation is the most common mechanism of sudden unexpected cardiac death in persons with asymptomatic or symptomatic coronary artery disease. The electrophysiologic mechanisms reviewed in this article include: automaticity of pacemaker fibers, transformation of nonpacemaker into pacemaker fibers, "injury" currents and reentry. Some of the conditions facilitating ventricular fibrillation include bradycardia, long QT syndrome, electrocution, electrolyte imbalance, drugs, sympathetic stimulation and myocardial ischemia. Electrophysiologic studies during acute myocardial ischemia suggest that the earliest activity at the onset of arrhythmia may originate at the sites of the surviving Purkinje fibers or at the epicardial rim. Reentrant arrhythmias arising in ischemic myocardium are attributed to nonhomogeneous distribution of local hyperkalemia and acidosis.
心室颤动是无症状或有症状冠状动脉疾病患者心源性猝死最常见的机制。本文所回顾的电生理机制包括：起搏纤维的自律性、非起搏纤维转变为起搏纤维、“损伤”电流和折返。一些促发心室颤动的情况包括心动过缓、长QT综合征、触电、电解质失衡、药物、交感神经刺激和心肌缺血。急性心肌缺血期间的电生理研究表明，心律失常发作时最早的活动可能起源于存活的浦肯野纤维部位或心外膜边缘。缺血心肌中出现的折返性心律失常归因于局部高钾血症和酸中毒的不均匀分布。
