Ischemic ventricular fibrillation: the importance of being spontaneous.
Ischemic ventricular fibrillation: the importance of being spontaneous.
复制标题
缺血性心室颤动：自发性的重要性。
DOI：
10.1016/0002-9149(81)90072-2
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发表时间：
1981
期刊：
影响因子：
--
通讯作者：
Varghese,PJ
中科院分区：
文献类型：
--
作者：
Ouyang,P;Brinker,JA;Bulkley,BH;Jugdutt,BI;Varghese,PJ
尽管根据诱发心室颤动的研究确定，正常心肌除颤所需的能量水平较低且恒定，但对于自发性或诱发心室颤动的局部缺血心脏的具体能量需求知之甚少。在这项研究中，使用心尖和上腔静脉电极以及提供 1 至 30 瓦秒可变输出的发生器，确定了 10 只开胸狗的除颤最低能量阈值，这些狗在不同部位进行了 44 次心室颤动事件中每一次的可逆 10 分钟冠状动脉闭塞。根据死后血管造影和平面测量数据定量，诱发心室颤动的狗（第 I 组）左心室的缺血质量为 52 ± 9%（平均值±标准差），闭塞后自发性心室颤动的狗（第 II 组）为 52 ± 12%，再灌注后自发性心室颤动的狗（第 III 组）为 54 ± 9%。除颤阈值以瓦秒为单位，第一组 (n = 12) 为 9 ± 7，第二组 (n = 13) 为 19 ± 10，第三组 (n = 19) 为 18 ± 10。 （第一组与第二组和第三组，概率 [p]<0.025）。在非缺血性心脏中，除颤阈值为 3 ± 2 (n = 32)（与 I、II 或 III 组的值相比，p <0.001）。因此，尽管缺血量相似，但自发性心室颤动（无论是闭塞后还是再灌注后）除颤所需的能量是诱发性心室颤动的两倍，这表明这些情况是由不同的代谢或病理紊乱引起的。在评估干预措施（例如旨在抑制重复性心室反应的药物治疗）和植入式除颤器的设计时应考虑此类差异。
Although the energy level required to defibrillate normal myocardium is low and constant, as determined from studies of induced ventricular fibrillation, little is known of the specific energy requirements in regionally ischemic hearts for spontaneous or induced ventricular fibrillation. In this study the lowest energy threshold for defibrillation was determined in 10 open chest dogs with reversible 10 minute coronary occlusions at various sites for each of 44 events of ventricular fibrillation, using apical and superior vena caval electrodes with a generator providing variable output of 1 to 30 watt seconds. The ischemic mass, quantitated from postmortem angiographic and planimetric data, was 52 ± 9 percent (mean ± standard deviation) of the left ventricle in dogs with induced ventricular fibrillation (Group I), 52 ± 12 percent in dogs with spontaneous ventricular fibrillation after occlusion (Group II) and 54 ± 9 percent in dogs with spontaneous ventricular fibrillation after reperfusion (Group III). Defibrillation thresholds in watt seconds were 9 ± 7 in Group I (n = 12), 19 ± 10 in Group II (n = 13) and 18 ± 10 in Group III (n = 19). (Group I versus Groups II and III, probability [p]<0.025). In nonischemic hearts, the defibrillation threshold was 3 ± 2 (n = 32) (p <0.001 compared with values in Group I, II or III). Thus, despite similar masses of ischemia, twice as much energy was required for defibrillation of spontaneous ventricular fibrillation (whether after occlusion or reperfusion) as for induced ventricular fibrillation, suggesting that these conditions are caused by different metabolic or pathologic derangements. Such differences should be considered in assessing interventions such as drug therapy designed to inhibit the repetitive ventricular response and in design of implantable defibrillators.