Circulation, Vol 65, 259-264, Copyright © 1982 by American Heart Association
FH Sheehan and SE Epstein
Coronary spasm can occur in the presence or absence of coronary artery
disease. We therefore determined the effect of preexisting coronary
stenosis on the incidence of ventricular fibrillation during reperfusion
after circumflex artery (CFX) occlusion. Twenty dogs underwent a 30-minute
open-chest CFX occlusion. During reperfusion, CFX blood flow was restricted
by a partial occluder. In dogs that survived reperfusion, peak CFX flow was
91 +/- 44% of baseline (mean +/- SD) compared with 163 +/- 68% in dogs that
died of ventricular fibrillation (p less than 0.02). In another 17 dogs,
the left anterior descending coronary artery was gradually occluded by an
ameroid constrictor. After 17-39 days, the CFX was acutely occluded for 30
minutes and then reperfused. Collateral flow to the CFX, measured by
microspheres, was 27.6 +/- 28.3 ml/min . 100 g-1 in dogs that died of
reperfusion ventricular fibrillation, compared with 64.4 +/- 27.2 ml/min .
100 g-1 in surviving dogs (p less than 0.02). Thus, the risk of reperfusion
ventricular fibrillation is greater in dogs with normal coronary arteries
than in dogs with a flow-limiting partial stenosis of the artery undergoing
transient occlusion, or chronic stenosis of a second coronary artery
inducing collateralization to the artery subsequently undergoing transient
occlusion. These results suggest that the risk of ventricular fibrillation
during release of coronary spasm may be greater in patients without than in
those with coronary artery disease.
ARTICLES
Determinants of arrhythmic death due to coronary spasm: effect of preexisting coronary artery stenosis on the incidence of reperfusion arrhythmia
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