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目的通过整体左室心内膜电生理标测研究长时间心室颤动(简称室颤)除颤成功后室颤早期复发的电生理作用机制。方法将64极伞状电极经颈动脉逆行植入6只正常比格犬的左室行电生理标测。通过快速电刺激,分别诱发20 s短时间室颤和7 min长时间室颤,随后给予体内双相波除颤。比较不同时间室颤除颤成功后最早激动时间和室颤复发率。利用电生理激动图分析室颤复发时的激动特征。结果 6只动物累计短时间室颤除颤成功24次,无1次室颤复发。7 min长时间室颤除颤成功6次,每次成功除颤后至少1次室颤早期复发,观察时间内累计复发14次,平均每只动物发作2.3±1.9次,与短时间室颤相比,室颤复发率显著升高(P<0.01)。与短时间室颤相比,长时间室颤除颤后最早激动时间显著延长(5 125±3 373 ms vs 322±166 ms,P<0.01)。14次复发室颤前,均有室性早搏。电生理标测提示,10次复发源自间隔部附近的局灶活动。结论无器质性心脏疾病的长时间室颤除颤成功后室颤早期复发十分常见,但未见于短时间室颤,提示长时间室颤本身可致室颤复发,其复发的起始电生理机制可能与局灶兴奋相关。
OBJECTIVE: To study the electrophysiological mechanism of early ventricular fibrillation recurrence after long-term ventricular fibrillation (VF) defibrillation through global left ventricular endocardial electrophysiological mapping. Methods Sixty-eight beagle dogs were electrophysiologically mapped on the left ventricle of 6 beagle dogs through retrograde carotid artery. Rapid electrical stimulation was used to induce short-term ventricular fibrillation for 20 s and long-term ventricular fibrillation for 7 min, respectively, followed by biphasic defibrillation in vivo. The earliest activation time and ventricular fibrillation recurrence rate after successful defibrillation of VF were compared. Analysis of the agitation characteristics of ventricular fibrillation recurrence using electrophysiological agitation imaging. Results In the short time of 6 animals, defibrillation of ventricular fibrillation was successful 24 times without recurrence of ventricular fibrillation. Seven minutes after defibrillation, the defibrillation of ventricular fibrillation was successful for 6 min. At least one episode of ventricular fibrillation was relapsed at least once after successful defibrillation. The recurrence was observed 14 times with an average of 2.3 ± 1.9 episodes per animal, The recurrence rate of ventricular fibrillation was significantly higher (P <0.01). Compared with short-term ventricular fibrillation, the earliest prolongation of ventricular fibrillation after prolonged VF was significantly longer (5 125 ± 3 373 ms vs 322 ± 166 ms, P <0.01). Premature ventricular fibrillation 14 times, both premature ventricular contractions. Electrophysiological mapping suggested that 10 recurrent events originated from focal activity near the septum. Conclusion The long-term ventricular fibrillation without structural heart disease after the successful defibrillation of ventricular fibrillation recurrence is very common early, but not seen in short-term ventricular fibrillation, suggesting that prolonged ventricular fibrillation can cause ventricular fibrillation recurrence, the recurrence of the initial electrophysiological Mechanisms may be related to focal arousal.