Transmural and endocardial Purkinje activation in pigs before local myocardial activation after defibrillation shocks
Transmural and endocardial Purkinje activation in pigs before local myocardial activation after defibrillation shocks
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DOI：
10.1016/j.hrthm.2007.02.017
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发表时间：
2007-06-01
期刊：
影响因子：
5.5
通讯作者：
Ideker, Raymond E.
中科院分区：
文献类型：
--
作者：
Dosdall, Derek J.;Cheng, Kang-An;Ideker, Raymond E.
背景在猪中最早记录的休克后心肌激活起源于休克后30-90 ms的左心室（LV）的心尖和外侧自由壁的心外膜下。目的本研究的目的是通过进行内皮和透壁休克后激活标测来确定浦肯野系统是否是休克后激活源的候选者。将带有12个电极（间距1 mm）的32个穿刺针插入LV心尖和外侧游离壁。将多达70个带有6个电极（间距2 mm）的穿刺针分布在LV的其余部分，同时将9-12个带有4个电极（间距2 mm）的穿刺针插入右心室。将具有32个双极记录部位的篮状导管插入LV。在10次电诱导室颤期间提供除颤阈值（DFT）水平电击。电击后激活周期的电图进行了分析，Purkinje和心肌activation. Results记录在第一次电击后激活周期的9%的篮电图和15%的柱塞针在局部心肌激活前的Purkinje激活。浦肯野激活过程中确定的第一个和随后的几个postshock激活周期中至少有一个篮子和一个针电图在96%和98%的除颤episodes，分别。需要进一步的研究来确定激活是否在浦肯野系统中启动，或者它是否被心肌或浦肯野-心肌连接细胞激活。
BACKGROUND Earliest recorded postshock myocardial activations in pigs originate in the subepicardium of the apex and lateral free wall of the left ventricle (LV) 30-90 ms after the shock.OBJECTIVE The purpose of this study was to determine whether the Purkinje system is a candidate for the source of postshock activations by performing endocardial and transmural postshock activation mapping.METHODS In five pigs, 32 plunge needles with 12 electrodes (1-mm spacing) were inserted into the LV apex and Lateral free wall. Up to 70 plunge needles with six electrodes (2-mm spacing) were spread throughout the remainder of the LV, while 9-12 plunge needles with four electrodes (2-mm spacing) were inserted into the right ventricle. A basket catheter with 32 bipolar recording sites was inserted into the LV. Defibrittation-threshold (DFT)-level shocks were delivered during 10 episodes of electrically induced ventricular fibrillation. Electrograms of postshock activation cycles were analyzed for Purkinje and myocardial activations.RESULTS Purkinje activations were recorded before Local myocardial activation in 9% of basket electrograms and in 15% of plunge needles during the first postshock activation cycle. Purkinje activations were identified during the first and subsequent several postshock activation cycles in at least one basket and one needle electrogram in 96% and 98% of defibrillation episodes, respectively.CONCLUSIONS The Purkinje system is active during the early postshock activation cycles after DFT-level shocks. Further studies are required to determine whether activation initiates in the Purkinje system or whether it is activated by the myocardium or by Purkinje-myocardial junctional cells.