Friedman H S, Kottmeier S, Melnicker L, McGuinn R, Shaughnessy E
J Am Coll Cardiol. 1984 Oct;4(4):729-34. doi: 10.1016/s0735-1097(84)80399-x.
Atrial fibrillation has a variable effect on myocardial blood flow in the intact heart. To assess its action on myocardial blood flow in the ischemic heart, measurements were made in nine dogs after ligation of the left anterior descending coronary artery before and during atrial fibrillation and with atrial pacing at the average ventricular response during atrial fibrillation. During atrial fibrillation, cardiac output decreased (from 2.4 +/- 0.2 to 1.5 +/- 0.2 liters/min, p less than 0.001) and mean aortic pressure decreased (from 90 +/- 9 to 72 +/- 7 mm Hg, p less than 0.001). Mean myocardial blood flow decreased from 63 +/- 9 to 51 +/- 9 ml/min per 100 g. Although myocardial blood flow decreased in ischemic myocardium (from 28 +/- 5 to 16 +/- 2 ml/min per 100 g, p less than 0.001), in nonischemic myocardium the changes were more variable (from 71 +/- 8 to 61 +/- 8 ml/min per 100 g, p = NS). During atrial pacing, mean and nonischemic regional myocardial blood flow were comparable with that in atrial fibrillation, whereas in the ischemic region, myocardial blood flow (20.3 +/- 3 versus 14.6 +/- 2.3 ml/min per 100 g, p less than 0.01) and left ventricular inner/outer layer ratio (0.43 +/- 0.07 versus 0.32 +/- 0.06, p less than 0.05) were lower. ST segment elevation increased with both atrial fibrillation (by 89 +/- 31%, p less than 0.05) and atrial pacing (by 51 +/- 28%). Thus, atrial fibrillation has an unfavorable influence on myocardial blood flow in the ischemic heart and worsens myocardial ischemia. This effect is at least in part due to the rapid ventricular rate.
心房颤动对完整心脏的心肌血流量有不同的影响。为了评估其对缺血性心脏心肌血流量的作用，在9只狗结扎左冠状动脉前降支后，于房颤前、房颤期间以及以房颤时的平均心室反应进行心房起搏时进行了测量。房颤期间，心输出量下降（从2.4±0.2升/分钟降至1.5±0.2升/分钟，p<0.001），平均主动脉压下降（从90±9毫米汞柱降至72±7毫米汞柱，p<0.001）。平均心肌血流量从每100克63±9毫升/分钟降至51±9毫升/分钟。虽然缺血心肌的心肌血流量下降（从每100克28±5毫升/分钟降至16±2毫升/分钟，p<0.001），但非缺血心肌的变化更具变异性（从每100克71±8毫升/分钟降至61±8毫升/分钟，p=无显著性差异）。心房起搏期间，平均和非缺血区域的心肌血流量与房颤时相当，而在缺血区域，心肌血流量（每100克20.3±3对14.6±2.3毫升/分钟，p<0.01）和左心室内/外层比值（0.43±0.07对0.32±0.06，p<0.05）较低。ST段抬高在房颤时（升高89±31%，p<0.05）和心房起搏时（升高51±28%）均增加。因此，心房颤动对缺血性心脏的心肌血流量有不利影响，并加重心肌缺血。这种影响至少部分归因于心室率过快。
