BIOLOGICAL EFFECTS OF SHOCK-WAVES - INDUCTION OF ARRHYTHMIA IN PIGLET HEARTS
BIOLOGICAL EFFECTS OF SHOCK-WAVES - INDUCTION OF ARRHYTHMIA IN PIGLET HEARTS
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DOI：
10.1016/0301-5629(94)90068-x
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发表时间：
1994-01-01
影响因子：
2.9
通讯作者：
CONZEN, P
中科院分区：
文献类型：
--
作者：
DELIUS, M;HOFFMANN, E;CONZEN, P
在通过电液或电磁碎石机进行碎石术期间，体外冲击波的应用必须与心电图同步，以减少心律失常的诱导。心动周期不应期与冲击波诱发心律失常之间的关系及其潜在机制尚未得到研究。在本实验中，在9只小猪中评估了对由液压碎石机在20 kV下施加的冲击波的心脏反应。病灶位于左心室心尖尾侧5、10和15 cm处，在一些仔猪中也位于心尖处。确定R波后的间期，在此期间，心脏对单次放电或冲击波爆发的冲击波刺激不敏感，即，以10 ms间隔分开的放电组。将该机械不应期与通过经静脉心内心房刺激确定的电不应期进行比较。因此，R波后的机械不应期在5 cm距离处为60 ms（单次放电）和70 ms（爆发）（中位数;范围10-180 ms）;两种刺激模式高度相关（r = 0.88）。虽然将焦点直接定位在距心尖10厘米处也获得了类似的结果，但爆发引起心脏反应的频率明显更高（9只小猪与2只小猪）。在15 cm距离处，完全没有获得响应。机械和电心房不应期在相似的范围内。在10 cm距离处通过冲击波脉冲群进行的更有效的心脏刺激与通过基于空化而不是直接冲击波效应的心律失常诱导相兼容。
During lithotripsy by electrohydraulic or electromagnetic lithotripters, the application of extracorporeal shock waves has to be synchronized with the electrocardiogram to reduce the induction of arrhythmias. The relation between the refractory period of the cardiac cycle and arrhythmia induction by shock waves, and the underlying mechanism have so far not been examined. In this experiment, the cardiac response to shock waves administered at 20 kV by an electrohydraulic lithotripter was assessed in nine piglets. The focus was positioned 5, 10 and 15 cm caudal to the apex of the left ventricle, and in some piglets also at the apex. The interval following the R-wave was determined during which the heart was refractory to shock wave stimulation by either single discharges or shock-wave bursts, i.e., groups of discharges separated by 10 ms intervals. This mechanical refractory period was compared to its electrical counterpart, which was determined by transvenous intracardiac atrial stimulation. As a result, mechanical refractory periods following the R-wave were at 5 cm distance 60 ms for single discharges and 70 ms for bursts (medians; range 10-180 ms); both stimulation modes were highly correlated (r = 0.88). While a similar result was obtained with the focus positioned directly at the cardiac apex, at 10 cm distance from it, bursts elicited a cardiac response significantly more often (in nine vs. two piglets). At 15 cm distance, no response was obtained at all. Both mechanical and electrical atrial refractory periods were in a similar range. The more effective cardiac stimulation by shock-wave bursts at 10 cm distance is compatible with the induction of arrhythmia by a cavitation-based instead of a direct shock wave effect.