Chemical ablation of the Purkinje system causes early termination and activation rate slowing of long-duration ventricular fibrillation in dogs
Chemical ablation of the Purkinje system causes early termination and activation rate slowing of long-duration ventricular fibrillation in dogs
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DOI：
10.1152/ajpheart.00466.2008
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发表时间：
2008-08-01
影响因子：
4.8
通讯作者：
Ideker, Raymond E.
中科院分区：
文献类型：
--
作者：
Dosdall, Derek J.;Tabereaux, Paul B.;Ideker, Raymond E.
心内膜标测显示浦肯野纤维可能在维持长时间室颤(LDVF)中起作用。为了确定浦肯野纤维对LDVF的影响，我们用Lugol溶液化学消融浦肯野系统，并在LDVF期间记录心内膜和跨室壁的激活。分离犬心脏并进行灌流，暴露心内膜后用Lugol液(n=6)或正常Tyrode液(n=6)处理。用504电极(21×24)标测左前乳头肌心内膜，电极间距1 mm。在斑块两侧用六电极穿刺针记录跨壁激活。诱发室颤(VF)，停止灌流。Lugol消融组自发终止LDVF的时间比对照组早(4.9±1.5min比9.2±3.2min，P=0.01)。在室颤终止后，对照组和Lugol心脏均表现为典型的可兴奋状态，但只能重新诱发短暂的室颤发作。在LDVF的前2分钟，Lugol消融组和对照心脏的心内膜激活率相似，但Lugol组的心内膜激动率在3分钟后显著减慢。在对照心脏中，LDVF 4min后，心内膜比心外膜激活得更快，波前最常从心内膜传到心外膜。在Lugol心脏中，没有观察到跨壁激活率和波前方向的差异。消融心内膜下加快了室颤的自发终止，改变了室颤的激活顺序，提示浦肯野纤维在维持室性心动过速中起重要作用。
Endocardial mapping has suggested that Purkinje fibers may play a role in the maintenance of long-duration ventricular fibrillation (LDVF). To determine the influence of Purkinje fibers on LDVF, we chemically ablated the Purkinje system with Lugol solution and recorded endocardial and transmural activation during LDVF. Dog hearts were isolated and perfused, and the ventricular endocardium was exposed and treated with Lugol solution (n = 6) or normal Tyrode solution as a control (n = 6). The left anterior papillary muscle endocardium was mapped with a 504-electrode (21 x 24) plaque with electrodes spaced 1 mm apart. Transmural activation was recorded with a six-electrode plunge needle on each side of the plaque. Ventricular fibrillation (VF) was induced, and perfusion was halted. LDVF spontaneously terminated sooner in Lugol-ablated hearts than in control hearts (4.9 +/- 1.5 vs. 9.2 +/- 3.2 min, P = 0.01). After termination of VF, both the control and Lugol hearts were typically excitable, but only short episodes of VF could be reinduced. Endocardial activation rates were similar during the first 2 min of LDVF for Lugol-ablated and control hearts but were significantly slower in Lugol hearts by 3 min. In control hearts, the endocardium activated more rapidly than the epicardium after 4 min of LDVF with wave fronts propagating most often from the endocardium to epicardium. No difference in transmural activation rate or wave front direction was observed in Lugol hearts. Ablation of the subendocardium hastens VF spontaneous termination and alters VF activation sequences, suggesting that Purkinje fibers are important in the maintenance of LDVF.