Prolongation of The Activation Time in Ischemic Myocardium is Associated with J-wave Generation in ECG and Ventricular Fibrillation
Prolongation of The Activation Time in Ischemic Myocardium is Associated with J-wave Generation in ECG and Ventricular Fibrillation
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DOI：
10.1038/s41598-019-48710-3
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发表时间：
2019-08-21
影响因子：
4.6
通讯作者：
Platonov, Pyotr G.
中科院分区：
文献类型：
--
作者：
Azarov, Jan E.;Ovechkin, Alexey O.;Platonov, Pyotr G.
J波模式已被认为是心律失常的风险标志物，特别是在心肌梗塞患者中。缺血时 J 波发展的机制仍不清楚。在心肌梗死模型中，我们评估了激活时间延迟作为 J 波出现的先决条件和心室颤动的预测因子。记录 14 只麻醉猪的体表心电图和心肌单极电图。 48 根壁内引线横跨心室游离壁和室间隔。通过结扎左冠状动脉前降支诱发心肌缺血，并在 40 分钟冠状动脉闭塞期间进行记录。局部激活时间被确定为单极电描记图 QRS 复合波期间 dV/dt 最小值的时刻。 11只动物在闭塞过程中，左心室游离壁中部、室间隔基底和中部的心室局部激动时间延长，心前导联出现J波。在逻辑回归和 ROC 曲线分析中，给定时间点的激活时间延迟与 J 波发展相关，较长的激活时间与心室颤动的出现相关。在实验性冠状动脉闭塞中，缺血心肌的激活延迟与体表心电图中 J 波的产生有关，并可预测心室颤动。
J-wave pattern has been recognized as an arrhythmic risk marker, particularly in myocardial infarction patients. Mechanisms underlying J-wave development in ischemia remain unknown. In myocardial infarction model, we evaluated activation time delay as a prerequisite ofJ-wave appearance and predictor of ventricular fibrillation. Body surface ECGs and myocardial unipolar electrograms were recorded in 14 anesthetized pigs. 48 intramural leads were positioned across ventricular free walls and interventricular septum. Myocardial ischemia was induced by ligation of the left anterior descending coronary artery and the recordings were done during 40-minute coronary occlusion. The local activation times were determined as instants of dV/dt minimum during QRS complex in unipolar electrograms. During occlusion, ventricular local activation time prolonged in the middle portion of the left ventricular free wall, and basal and middle portions of septum, while J-waves appeared in precordial leads in 11 animals. In logistic regression and ROC curve analyses, activation time delay at a given time-point was associated with J-wave development, and a longer activation time was associated with ventricular fibrillation appearance. In experimental coronary occlusion, activation delay in ischemic myocardium was associated with generation of the J waves in the body surface ECG and predicted ventricular fibrillation.