El-Sherif N, Scherlag B J, Lazzara R, Hope R R
Circulation. 1977 May;55(5):686-702. doi: 10.1161/01.cir.55.5.686.
Dogs 3-7 days following ligation of the anterior descending coronary artery representing a remarkably stable model for re-entrant ventricular arrhythmias (RVA) and allowed detailed electrophysiologic studies of the re-entrant mechanism. In these dogs, we could regularly illustrate the presence of continuous electrical activity originating from the infarction zone (IZ) and bridging the diastolic interval between the initiating and re-entrant beats as well as between consecutive re-entrant beats. Conduction in the IZ was highly complex, with multiple potentially re-entrant pathways, functionally dissociated areas, and areas of localized ventricular fibrillation. Conduction disorders in ischemic myocardium were consistently tachycardia-dependent with the spontaneous onset of RVA specifically associated with a Wenckebach-like conduction pattern in a potentially re-entrant pathway. Both manifest and concealed re-entry, as well as re-entrant beats with regular extrasystolic grouping, constant or variable coupling, uniform multiform and bidirectional QRS configurations, were related to characteristic conduction patterns in the IZ. In summary, the study provides the first direct in vivo evidence of ventricular re-entry and demonstrates propensity for RVA and sudden death in the late myocardial infarction period.
结扎冠状动脉前降支3至7天的犬类代表了一种用于折返性室性心律失常（RVA）的非常稳定的模型，并允许对折返机制进行详细的电生理研究。在这些犬类中，我们能够定期证明存在源自梗死区（IZ）的持续性电活动，该电活动跨越起始搏动与折返搏动之间以及连续折返搏动之间的舒张期。IZ内的传导高度复杂，具有多个潜在的折返途径、功能分离区域和局部心室颤动区域。缺血心肌中的传导障碍始终依赖于心动过速，RVA的自发发作与潜在折返途径中的文氏传导样模式特别相关。显性和隐匿性折返，以及具有规则早搏分组、恒定或可变耦合、均匀多形和双向QRS形态的折返搏动，均与IZ中的特征性传导模式有关。总之，该研究提供了心室折返的首个直接体内证据，并证明了心肌梗死后期发生RVA和猝死的倾向。
