Altered dynamics of action potential restitution and alternans in humans with structural heart disease
Altered dynamics of action potential restitution and alternans in humans with structural heart disease
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DOI：
10.1161/circulationaha.104.502831
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发表时间：
2005-09-13
期刊：
影响因子：
37.8
通讯作者：
Gilmour, RF
中科院分区：
文献类型：
--
作者：
Koller, ML;Maier, SKG;Gilmour, RF
研究背景-静息动力学和心室动作电位时程（APD）交替已被证明是心脏电稳定性的重要决定因素。在这项研究中，我们测试的假设，APD恢复和交替属性不同正常和患病的人心室myocardial.Methods和Results -单相动作电位记录从右室间隔在24例结构性心脏病（SHD）和12例无SHD。通过绘制APD作为前一舒张间期的函数来构建标准和动态恢复关系。两组的动态恢复关系显示，在短舒张间期时，与APD交替的发生相关的是一个陡峭的斜坡段。与无SHD的患者相比，SHD患者存在APD交替的舒张间期范围更宽（平均值+/- SEM 68 +/- 11 vs 12 +/- 2 ms），并且显示APD交替的发作更早（168 +/- 7 vs 225 +/- 4 bpm）和幅度增加（20 +/- 2 vs 11 +/- 2 ms）。诱导室性心动过速（6集）和快速起搏过程中APD电交替的发生可以从动态restitution function.Conclusions -有显着差异的动态APD恢复和交替在SHD患者的心室肌与SHD患者相比，没有SHD。这些差异可能是重要的心脏电不稳定性在患病的人的心脏，并可能代表一个有前途的抗心律失常底物修饰的目标。
Background - Restitution kinetics and alternans of ventricular action potential duration (APD) have been shown to be important determinants of cardiac electrical stability. In this study, we tested the hypothesis that APD restitution and alternans properties differ between normal and diseased human ventricular myocardium.Methods and Results - Monophasic action potentials were recorded from the right ventricular septum in 24 patients with structural heart disease (SHD) and in 12 patients without SHD. Standard and dynamic restitution relations were constructed by plotting APD as a function of the preceding diastolic interval. The dynamic restitution relation of both groups showed a steeply sloped segment at short diastolic intervals that was associated with the occurrence of APD alternans. Patients with SHD had a wider diastolic interval range over which APD alternans was present ( mean +/- SEM 68 +/- 11 versus 12 +/- 2 ms) and showed an earlier onset ( 168 +/- 7 versus 225 +/- 4 bpm) and an increased magnitude ( 20 +/- 2 versus 11 +/- 2 ms) of APD alternans compared with patients without SHD. The occurrence of APD alternans during induced ventricular tachycardia ( 6 episodes) and during rapid pacing could be derived from the dynamic restitution function.Conclusions - There are marked differences in the dynamics of APD restitution and alternans in the ventricular myocardium of patients with SHD compared with patients without SHD. These differences may contribute importantly to cardiac electrical instability in diseased human hearts and may represent a promising target for antiarrhythmic substrate modification.