Rate Dependent Ventricular Ectopia Following Acute Coronary Occlusion: The Concept of An Optimal Antiarrhythmic Heart Rate
Rate Dependent Ventricular Ectopia Following Acute Coronary Occlusion: The Concept of An Optimal Antiarrhythmic Heart Rate
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DOI：
10.1161/01.cir.49.4.654
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发表时间：
1974-04
期刊：
影响因子：
37.8
通讯作者：
K. Chadda;V. S. Banka;R. Helfant
中科院分区：
文献类型：
--
作者：
K. Chadda;V. S. Banka;R. Helfant
最近的报告表明，心动过速和心动过缓可能在急性心肌梗塞中导致心律失常。本实验研究旨在利用窦房结挤压和心房起搏系统地评估心率在广泛范围内的致心律失常和抗心律失常作用。在24只开胸犬的左冠状动脉前降支结扎前后，以60-200次/分钟的速率连续记录最长三小时的表面心电图和局部心电图。冠状动脉闭塞后，心室异位复合波的发生率为 7.6 ± 1.6/min，速率为 60，并逐渐下降至 2.5 ± 0.4/min，速率为 90 (P < 0.01)。注意到速率为 110-150 ⪕ 1 心室异位复合波/分钟。然而，当比率达到 180 及以上时，心室异位复合波的发生率急剧增加，并有 17 次诱发室性心动过速和/或颤动。同样，在心率为 60-90 时，有 16 次出现室性心动过速和/或颤动，但在心率为 110-150 时从未出现过。局部电图显示明显的 ST 段抬高，心率较高，与局部缺血增加相一致。结论是，急性冠状动脉闭塞后，心室异位在快心率和慢心率时更常见。似乎存在最大抗心律失常作用的最佳中间速率。
Recent reports have indicated that tachycardia as well as bradycardia may be arrhythmogenic in acute myocardial infarction. The present experimental study was designed to systematically evaluate the arrhythmogenic and antiarrhythmic effect of heart rate over a wide spectrum using sinus node crush and atrial pacing. Serial recordings of the surface electrocardiograms and local electrograms for a maximum period of three hours were taken at rates of 60-200 beats/min before and after ligation of the left anterior descending coronary artery in 24 open chested dogs. Immediately following coronary occlusion, the incidence of ventricular ectopic complexes was 7.6 ± 1.6/min at a rate of 60, and gradually decreased to 2.5 ± 0.4/min at a rate of 90 (P < 0.01). At rates of 110-150 ⪕ 1 ventricular ectopic complex/min was noted. However, at rates of 180 and above, the incidence of ventricular ectopic complexes dramatically increased with frank ventricular tachycardia and/or fibrillation being provoked on seventeen occasions. Similarly, at rates of 60-90, ventricular tachycardia and/or fibrillation was exhibited on sixteen occasions, but never at rates between 110-150. Local electrograms exhibited marked ST segment elevation with higher heart rates compatible with increased local ischemia. It is concluded that ventricular ectopia is more common at rapid as well as slow heart rates after acute coronary occlusion. There appears to be an optimal intermediate rate for maximal antiarrhythmic effect.