Jalife J, Moe G K
Circ Res. 1981 Jul;49(1):233-47. doi: 10.1161/01.res.49.1.233.
When an impulse arrives at an area of impaired conductivity, a slowly rising electrotonic potential may bring the distal tissue to threshold after a delay imposed by the passive electrical properties of the system and by the time-dependent changes of these properties during diastole. This phenomenon can be demonstrated in Purkinje strands in which an area of depressed conductivity has been induced by the impedance of a sucrose gap and can be mimicked by the application of relatively long current pulses of low amplitude. The functional refractory period, defined as the shortest interval between two distal responses both propagated across the gap, was determined by the application of premature stimuli at progressively earlier intervals. The time course of the recovery of excitability as well as the conduction intervals could be varied almost at will by manipulating the electric impedance between proximal and distal ends of the fiber. When the time of activation of the distal end across the gap exceeded the absolute refractory period of the proximal segment, the impulse reflected back as a closely coupled premature beat. Time-dependent changes in the passive electrical properties of the depressed segment may set the conditions for reflection. The results suggest the possibility of reflection as a mechanism for premature beats and demonstrate obligatory shifts in the patterns of premature reentrant activity accompanying changes in basic cycle length. These experiments provide important clues for the distinction between reentrant and parasystolic mechanisms.
当冲动到达传导受损区域时,一个缓慢上升的电紧张电位可能会在系统的被动电学特性以及舒张期这些特性随时间的变化所造成的延迟之后,使远端组织达到阈电位。这种现象可以在浦肯野纤维束中得到证明,在该纤维束中,蔗糖间隙的阻抗已诱发了一个传导性降低的区域,并且通过施加相对较长的低幅度电流脉冲可以模拟这种现象。功能性不应期定义为两个均通过间隙传播的远端反应之间的最短间隔,它是通过以逐渐提前的间隔施加早搏刺激来确定的。通过操纵纤维近端和远端之间的电阻抗,兴奋性恢复的时间进程以及传导间隔几乎可以随意改变。当通过间隙激活远端的时间超过近端节段的绝对不应期时,冲动会作为紧密耦合的早搏折返回来。传导性降低节段的被动电学特性随时间的变化可能为折返创造条件。结果表明折返有可能作为早搏的一种机制,并证明了伴随基本周期长度变化的早搏折返活动模式的必然转变。这些实验为区分折返机制和并行心律机制提供了重要线索。