The long and the short of long and short duration ventricular fibrillation.
The long and the short of long and short duration ventricular fibrillation.
复制标题
长时程和短时程心室颤动的长短。
DOI：
10.1161/circresaha.108.177303
复制
发表时间：
2008
影响因子：
20.1
通讯作者：
Trayanova,NataliaA
中科院分区：
文献类型：
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作者：
Trayanova,NataliaA
心室颤动（VF）期间复杂激动序列背后的机制多年来一直是深入研究的主题。VF的动物模型中的实验研究以及人类VF的临床研究1-8提供了大量关于心脏电活动性质的数据。辅以计算机模拟和波在可兴奋介质中传播的理论框架，我们的社区已经积累了重要的见解，导致电活动退化为VF和VF维持的机制。然而，这些研究中的大多数都致力于VF发作后短时间内的VF机制（短持续时间VF，持续时间小于1分钟）。在医院外发生心脏骤停时，第一次除颤电击的中位时间为4.4分钟，11 VF发作通常持续长达10分钟（长持续时间VF）;在此期间，心脏缺血，同时受到过高的兴奋率。心肌的电生理特性的变化发生在这些长持续时间的VF发作。这反映在除颤电击的结果改变中，存活率随着VF时间的增加而迅速下降。12类似地，最佳复苏治疗的指导方针根据VF持续时间而不同：如果VF发作时间小于4或5分钟，则规定立即除颤，而当VF持续4或5至10分钟时，在除颤电击之前给予CPR最多3分钟被认为可以改善结果。13，14由于对VF长期维持的机制知之甚少，获得这些知识有望大大有助于开发治疗方法，增加VF持续存在的生存几率。Li等人15在本期《循环研究》中的研究是为数不多的16，17，试图表征心脏电活动在长时间VF，当然是最全面的。作者记录了猪10分钟的电诱导VF。使用由99根针（每根针6个电极）组成的透壁阵列，在3.9 cm 3的前壁体积中标测3D激动序列。
The mechanisms behind the complex activation sequences during ventricular fibrillation (VF) have been the topic of intense research over many years. Experimental studies in animal models of VF, as well as clinical studies of human VF, 1–8 have provided a wealth of data on the nature of electric activity in the fibrillating heart. Supplemented by computer simulations and a theoretical framework of wave propagation in excitable media, 9, 10 our community has amassed significant insights into the mechanisms that lead to the degradation of electric activity into VF and of VF maintenance. However, the majority of these studies have been devoted to VF mechanisms in the short time period after VF onset (shortduration VF, lasting less than 1 minute). In an episode of cardiac arrest outside of the hospital, the median time to delivery of the first defibrillation shock is 4.4 minutes, 11 with VF episodes often lasting as long as 10 minutes (longduration VF); over this period, the heart becomes ischemic while being subjected to excessively high excitation rates. Changes in the electrophysiological properties of the myocardium take place over these long-duration VF episodes. This is reflected in the altered outcome of a defibrillation shock, with survival rates decreasing rapidly with the increase in minutes spent in VF. 12 Similarly, the guidelines for optimal resuscitation therapy differ depending on VF duration: immediate defibrillation is prescribed if time from VF onset is less than 4 or 5 minutes, whereas giving CPR for up to 3 minutes in advance of the defibrillation shock is believed to improve outcome when VF persists for 4 or 5 to 10 minutes. 13, 14 Because little is known about the mechanisms of VF maintenance over long periods of fibrillatory activity, acquiring such knowledge is expected to contribute significantly to the development of therapies that increase the survival odds as VF persists.The study by Li et al15 in this issue of Circulation Research is among a very few16, 17 that have attempted to characterize cardiac electric activity in long-duration VF and certainly the most comprehensive. The authors recorded 10 minutes of electrically induced VF in pigs. A transmural array consisting of 99 needles with 6 electrodes per needle was used to map 3D activation sequences in a 3.9-cm3 volume of the anterior