Circulation, Vol 69, 790-800, Copyright © 1984 by American Heart Association
PJ Schwartz, GE Billman and HL Stone
The relationship between activity of the autonomic nervous system,
myocardial ischemia, and malignant arrhythmias has been investigated in a
new experimental preparation for sudden death. Fifty-seven dogs were
chronically instrumented and studied under control conditions (n = 15) and
1 month after production of an anterior myocardial infarction (n = 42). The
protocol consisted in occluding the left circumflex coronary artery for 2
min, commencing at the last minute of an exercise stress test and extending
through the first minute after cessation of exercise. With this protocol,
ventricular fibrillation was observed in 40% of normal dogs and 66% of dogs
with infarction. In 14 dogs with infarction, left stellectomy reduced the
incidence of ventricular fibrillation to zero (p less than .001). The
reflex changes in heart rate elicited within the first minute of ischemia
during exercise in the animals that survived (from 204 +/- 14 to 198 +/- 31
beats/min, -6) were opposite those in animals that had ventricular
fibrillation (from 208 +/- 24 to 229 +/- 30 beats/min, +21) (p less than
.05). The ischemia-induced reduction in heart rate despite continuation of
exercise suggests the presence in the dogs that survived of active vagal
reflexes that may have played an important role in the maintenance of
cardiac electrical stability. This preparation has the potential to induce
ventricular fibrillation consistently in conscious animals by the
interaction of a few clinically relevant factors (acute myocardial
ischemia, submaximal exercise and its cessation, sympathetic and vagal
reflexes, and heart rate) and offers the possibility of acquiring further
insights into the mechanisms of malignant arrhythmias and evaluating novel
strategies for targeted prevention.
ARTICLES
Autonomic mechanisms in ventricular fibrillation induced by myocardial ischemia during exercise in dogs with healed myocardial infarction. An experimental preparation for sudden cardiac death
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