Naito M, David D, Michelson E L, Schaffenburg M, Dreifus L S
Am Heart J. 1983 Aug;106(2):284-91. doi: 10.1016/0002-8703(83)90194-1.
To evaluate the hemodynamic consequences of various cardiac arrhythmias, hemodynamic and angiographic studies were performed on 20 open-chest, atrioventricular (AV) heart-blocked dogs during various programmed pacing protocols. Protocols included AV pacing at intervals of 100 msec and -100 msec, ventricular (V) pacing during AV dissociation, and V pacing during atrial fibrillation (AF). In addition, the effects of regular versus irregular V pacing were also evaluated. During regular V pacing, cardiac output was optimal at an AV interval of 100 msec, but decreased by 25% at AV -100 msec and by 18% during both AV dissociation and AF. During irregular V cycles, cardiac output decreased further (e.g., by an additional 7% during AF). Pulmonary venous regurgitation was observed only during AV dissociation and during regular pacing at AV -100 msec. Notably, mitral valvular regurgitation was observed only during irregular V cycles, but not during regular V pacing, even in the presence of AV dissociation or AF. Using these methods it was possible to resolve some previously reported controversies regarding the relative importance of AV sequencing, atrial systole versus AF, regular versus irregular rhythms, as well as the possible contribution of mitral and/or pulmonary venous regurgitation to the adverse hemodynamics of various cardiac arrhythmias.
为评估各种心律失常的血流动力学后果，在20只开胸、患有房室（AV）传导阻滞的犬身上，于各种程控起搏方案期间进行了血流动力学和血管造影研究。方案包括以100毫秒和 -100毫秒的间期进行房室起搏、房室分离期间的心室（V）起搏以及心房颤动（AF）期间的心室起搏。此外，还评估了规则与不规则心室起搏的影响。在规则心室起搏期间，心输出量在房室间期为100毫秒时最佳，但在房室间期为 -100毫秒时降低25%，在房室分离和心房颤动期间降低18%。在不规则心室周期期间，心输出量进一步降低（例如，在心房颤动期间再降低7%）。仅在房室分离期间以及在房室间期为 -100毫秒的规则起搏期间观察到肺静脉反流。值得注意的是，仅在不规则心室周期期间观察到二尖瓣反流，而在规则心室起搏期间未观察到，即使存在房室分离或心房颤动。使用这些方法有可能解决一些先前报道的关于房室顺序、心房收缩与心房颤动的相对重要性、规则与不规则节律以及二尖瓣和/或肺静脉反流对各种心律失常不良血流动力学可能贡献的争议。
