ACTIVATION DURING VENTRICULAR DEFIBRILLATION IN OPEN-CHEST DOGS - EVIDENCE OF COMPLETE CESSATION AND REGENERATION OF VENTRICULAR-FIBRILLATION AFTER UNSUCCESSFUL SHOCKS
ACTIVATION DURING VENTRICULAR DEFIBRILLATION IN OPEN-CHEST DOGS - EVIDENCE OF COMPLETE CESSATION AND REGENERATION OF VENTRICULAR-FIBRILLATION AFTER UNSUCCESSFUL SHOCKS
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DOI：
10.1172/jci112378
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发表时间：
1986-03-01
影响因子：
15.9
通讯作者：
IDEKER, RE
中科院分区：
文献类型：
--
作者：
CHEN, PS;SHIBATA, N;IDEKER, RE
为了验证除颤休克是不成功的假设，因为它不能消灭临界质量的心肌的激活前沿，我们记录了11只开胸狗在电致心室颤动（VF）期间的心外膜和跨壁激活。1- 30j的电击通过左心室尖部和右心房的除颤电极传递。同时用不同组合的室间隔、壁内和心外膜电极进行记录。在所有104次不成功和116次成功除颤后，等电间隔比震前VF期间观察到的要长得多。在此期间未观察到心外膜、隔膜或壁内活化。等电窗平均为64。除颤失败后22 ms和339 .+-。除颤成功后292 ms （P < 0.02）。在电击失败的等电窗后，最早的激活记录来自心室底部，这是距离根尖除颤电极最远的区域。在不成功的冲击后，激活同步进行一到两个周期，之后VF再生。因此，(a)除颤成功和不成功的心外膜电击后。1 J为等电窗，在此期间不存在激活锋；(b)除颤失败者的电击后等电窗比除颤成功者短；(c)不成功的冲击在纤颤再生之前瞬间同步激活；(d)在不成功电击的等电窗后，导致VF再生的激活起源于远离除颤电极的区域。等电窗并不支持除颤失败仅仅是因为激活前未在心肌临界质量内停止的假设。相反，不成功的心外膜电击。1j停止所有激活前，之后VF再生。
To test the hypothesis that a defibrillation shock is unsuccessful because it fails to annihilate activation fronts within a critical mass of myocardium, we recorded epicardial and transmural activation in 11 open-chest dogs during electrically induced ventricular fibrillation (VF). Shocks of 1-30 J were delivered through defibrillation electrodes on the left ventricular apex and right atrium. Simultaneous recordings were made from septal, intramural, and epicardial electrodes in various combinations. Immediately after all 104 unsuccessful and 116 successful defibrillation shocks, an isoelectric interval much longer than that observed during preshock VF occurred. During this time no epicardial, septal, or intramural activations were observed. This isoelectric window averaged 64 .+-. 22 ms after unsuccessful defibrillation and 339 .+-. 292 ms after successful defibrillation (P < 0.02). After the isoelectric window of unsuccessful shocks, earliest activation was recorded from the base of the ventricles, which was the area farthest from the apical defibrillation electrode. Activation was synchronized for one or two cycles following unsuccessful shocks, after which VF regenerated. Thus, (a) after both successful and unsuccessful defibrillation with epicardial shocks of .gtoreq. 1 J, an isoelectric window occurs during which no activation fronts are present; (b) the postshock isoelectric window is shorter for unsuccessful than for successful defibrillation; (c) unsuccessful shocks transiently synchronize activation before fibrillation regenerates; (d) activation leading to the regeneration of VF after the isoelectric window for unsuccessful shocks originates in areas away from the defibrillation electrodes. The isoelectric window does not support the hypothesis that defibrillation fails solely because activation fronts are not halted within a critical mass of myocardium. Rather, unsuccessful epicardial shocks of .gtoreq. 1 J halt all activation fronts after which VF regenerates.