Harumi K, Smith G R, Abildskov J A, Burgess M J, Lux R L, Wyatt R F
Jpn Heart J. 1980 Jul;21(4):533-44. doi: 10.1536/ihj.21.533.
We determined the details of ventricular activation sequence during the onset of ventricular fibrillation in 6 dogs. Unipolar electrograms were simultaneously recorded from 192 ventricular epicardial sites evenly spaced in a 3 by 3 cm square area surrounding 2 central sites to which stimuli for inducing fibrillation were delivered. In 5 dogs, 2 to 10 msec duration pulses with amplitudes of 150 to 220 v were used to induce fibrillation, and in 1 dog, 3 successive permature stimuli of 3 v intensity were used to induce fibrillation. In 2 dogs the pattern of activation at the onset of fibrillation was compatible with local reentrant paths near the stimulus site. Fibrillation was induced with a single high intensity pulse in both of these dogs. In the other 4 dogs, the pattern of activation at the onset of fibrillation was highly suggestive of reentrant paths distant from the stimulating electrodes. In 3 of these dogs fibrillation was induced by a single high intensity pulse and in the other it was induced by 3 repetitive stimuli. Activation patterns resembling supraventricular activation occurred prior to fibrillation in the latter animal. The data demonstrate 2 distinct modes of onset of electrically induced ventricular fibrillation. The findings support local reentry in the region of the stimulus site as the mode of onset of fibrillation in some animals and possible reentry at sites distant from the stimulus site with participation of the specialized conduction system in other animals. The differences in mode of onset of electrically induced fibrillation may be responsible for instability of fibrillation threshold measurements in some animals. In addition the role of the specialized conduction system in the onset of fibrillation may be responsible for the effects of sympathetic and vagal stimulation on fibrillation threshold.
我们确定了6只犬心室颤动发作期间心室激动顺序的细节。在围绕两个施加致颤刺激的中心部位的3×3平方厘米区域内，从192个均匀分布的心室心外膜部位同时记录单极电图。在5只犬中，使用持续时间为2至10毫秒、幅度为150至220伏的脉冲诱发颤动，在1只犬中，使用3次强度为3伏的连续早搏刺激诱发颤动。在2只犬中，颤动发作时的激动模式与刺激部位附近的局部折返路径相符。这两只犬均由单个高强度脉冲诱发颤动。在另外4只犬中，颤动发作时的激动模式强烈提示折返路径远离刺激电极。其中3只犬由单个高强度脉冲诱发颤动，另一只由3次重复刺激诱发。在后者的动物中，类似室上性激动的激动模式在颤动之前出现。数据表明电诱发心室颤动有两种不同的发作模式。这些发现支持在某些动物中，刺激部位区域的局部折返作为颤动发作模式，而在其他动物中，可能在远离刺激部位的部位发生折返并伴有特殊传导系统的参与。电诱发颤动发作模式的差异可能是某些动物颤动阈值测量不稳定的原因。此外，特殊传导系统在颤动发作中的作用可能是交感神经和迷走神经刺激对颤动阈值产生影响的原因。
