Long-duration ventricular fibrillation exhibits 2 distinct organized states.
Long-duration ventricular fibrillation exhibits 2 distinct organized states.
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DOI：
10.1161/circep.113.000459
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发表时间：
2013-12
期刊：
影响因子：
--
通讯作者：
Ideker RE
中科院分区：
文献类型：
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作者：
Li L;Zheng X;Dosdall DJ;Huang J;Pogwizd SM;Ideker RE
先前的研究表明，长时间心室颤动（VF）时的心内膜激活表现出有组织的活动。我们确定并量化了不同类型的有组织活动。将两根64电极的筐式导管分别插入狗的左心室和右心室，记录7分钟VF期间心内膜的激活情况（对照组，n=6）。用KATP通道开启剂pinacidil （n=6）和钙通道阻滞剂氟桂利嗪（n=6）重复研究。无药VF 2min后，观察到2种高度组织化的左心室心内膜激活模式：(1)心室电同步模式，心内膜激活局部出现，或具有类似窦性心律的传播序列，或在乳头肌附近出现；(2)稳定模式，激活规则且可重复，有时在左心室心尖周围形成稳定的再入回路。在心室颤动3 ~ 7分钟，出现心室电同步的时间百分比为对照组=25%，氟桂利嗪=24% (P=0.44), pinacidil=0.1% (P<0.001)，出现稳定模式的时间百分比为对照组=71%，氟桂利嗪=48% (P<0.001), pinacidil=56% （P<0.001）。剩下的时间里，不稳定的可重入激活几乎没有可重复性。3分钟后，VF在96%的时间内表现出2种高度组织化的心内膜激活模式，一种可能是局部发生在浦肯脑系统，可以用KATP通道打开剂而不是钙通道阻滞剂来阻止，另一种可能是由左室心内膜顶端附近的稳定再入电路引起的。
Previous studies showed that endocardial activation during long-duration ventricular fibrillation (VF) exhibits organized activity. We identified and quantified the different types of organized activity. Two 64-electrode basket catheters were inserted, respectively, into the left ventricle and right ventricle of dogs to record endocardial activation from the endocardium during 7 minutes of VF (controls, n=6). The study was repeated with the KATP channel opener pinacidil (n=6) and the calcium channel blocker flunarizine (n=6). After 2 minutes of VF without drugs, 2 highly organized left ventricular endocardial activation patterns were observed: (1) ventricular electric synchrony pattern, in which endocardial activation arose focally and either had a propagation sequence similar to sinus rhythm or arose near papillary muscles, and (2) stable pattern, in which activation was regular and repeatable, sometimes forming a stable re-entrant circuit around the left ventricular apex. Between 3 and 7 minutes of VF, the percent of time ventricular electric synchrony was present was control=25%, flunarizine=24% (P=0.44), and pinacidil=0.1% (P<0.001) and the percent of time stable pattern was present was control=71%, flunarizine=48% (P<0.001), and pinacidil=56% (P<0.001). The remainder of the time, nonstable re-entrant activation with little repeatability was present. After 3 minutes, VF exhibits 2 highly organized endocardial activation patterns 96% of the time, one potentially arising focally in the Purkinje system that was prevented with a KATP channel opener but not a calcium channel blocker and the other potentially arising from a stable re-entrant circuit near the apical left ventricular endocardium.