MECHANISMS OF CARDIAC FIBRILLATION
MECHANISMS OF CARDIAC FIBRILLATION
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DOI：
10.1126/science.270.5239.1222
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发表时间：
1995-11-17
期刊：
影响因子：
56.9
通讯作者：
PERTSOV, AM
中科院分区：
文献类型：
--
作者：
GRAY, RA;JALIFE, J;PERTSOV, AM
许多机制已被提出来解释心室颤动，这是心脏性猝死的前兆，是工业化国家的主要死亡原因（1）。亚瑟T. Winfree（2）涉及三维（30）电活动转子，当心脏厚度超过某个临界值时，转子变得不稳定。Winfree（2，第1006页）指出，”几个固定的转子将共同类似于纤维性颤动......心电图和单独的心外膜电极仍将揭示其单独的局部周期性。“虽然有吸引力，但这样的想法仍然是投机性的。即使是最复杂的系统也只能从有限数量的部位记录细胞外电位（3），这使得在纤颤期间难以证明多个转子。此外，据我们所知，实验数据尚未显示两个以上的同时转子以不同频率激活心室并导致纤颤。我们已经使用电压敏感探针和高分辨率视频成像来记录心室颤动期间离体兔子心脏表面上的电波传播（4）。在这里，我们提出了直接的实验证据，即使是一个单一的快速移动的转子可以引起类似于颤动的心电图模式。在三次纤维性颤动发作中，来自心室表面的跨膜电位信号的视频”电影”展示了与如由心电图（ECG）记录的湍流电活动相关联的单个快速移动转子（图1A）。具体而言，当转子（上图）沿心脏表面（中间）上的复杂轨迹沿着漂移时，ECG显示不规则的周期性和形态（下图）。为了补充我们对表面数据的实验研究，我们进行了计算机模拟，结合了更逼真的3D心脏几何形状（5）。与
Many mechanisms have been proposed to explain ventricular fibrillation, which is the precursor to sudden cardiac death, the leading cause ofdeath in the industrialized world (1). A recent hypothesis discussed by Arthur T. Winfree (2) involves three-dimensional (30) rotors of electrical activity that become unstable when the heart thickness exceeds some critical value. Winfree (2, p. 1006) states," Several pinned rotors would collectively resemble fibrillation in the... electrocardiogram, and individual epicardial electrodes would still reveal their individual local periodicities." Although attractive, such an idea remains speculative. Even the most sophisticated systems record extracellular potentials from only a limited number of sites (3), making the demonstration of multiple rotors during fibrillation difficult. Moreover, to our knowledge, experimental data are not available as yet showing more than two simultaneous rotors activating the ventricles at various frequencies and resulting in fibrillation. We have used voltagesensitive probes and high-resolution video imaging to record electrical wave propagation on the surface of the isolated rabbit heart during ventricular fibrillation (4). Here we present direct experimental evidence that even a single rapidly moving rotor can give rise to electrocardiographic patterns that resemble fibrillation. In three episodes of fibrillation, video" movies" of the transmembrane potential signal from the ventricular surface demonstrated a single rapidly moving rotor associated with turbulent electrical activity as recorded by an electrocardiogram (ECG)(Fig. IA). Specifically, as the rotor (top panel) drifted along complex trajectories on the heart surface (middle), the ECG displayed irregular periodicity and morphology (bottom). To complement our experimental studies of surface data, we conducted computer simulations incorporating more realistic 3D heart geometry (5). With the