Circulation, Vol 90, 139-147, Copyright © 1994 by American Heart Association
JA Goldstein, MC Butterfield, Y Ohnishi, TJ Shelton and PB Corr
BACKGROUND: Patients with acute coronary artery thrombosis often develop
primary malignant ventricular arrhythmias (MVA) early after coronary
occlusion. In contrast, acute ischemia induced by nonthrombotic balloon
occlusion during routine coronary angioplasty rarely elicits such
arrhythmias. This study was designed to assess the role of intracoronary
thrombosis in arrhythmogenesis during acute ischemia. METHODS AND RESULTS:
We compared the incidence of MVA associated with acute left anterior
descending coronary artery (LAD) thrombosis elicited in open-chest
anesthetized dogs by electrical injury (n = 10) or intracoronary stent (n =
9) versus LAD balloon occlusion (n = 15). Compared with animals subjected
to balloon occlusion, those with thrombotic occlusion had a significantly
greater incidence of MVA, defined as nonsustained ventricular tachycardia
(total duration > 10 seconds), sustained ventricular tachycardia, or
ventricular fibrillation developing within the first 30 minutes of
occlusion. In the combined thrombosis groups, MVA developed in 11 of 19
animals (58%) (6 of 10 dogs with electrical injury and 5 of 9 stent
animals). In contrast, MVA occurred in only 1 of 15 animals (7%) subjected
to balloon occlusion. This striking and significant difference in
arrhythmias occurred despite the fact that radioactive microsphere
perfusion analysis documented that the extent of left ventricular
myocardium rendered ischemic was equal in all groups (percent of left
ventricular myocardium with occlusion flow < or = 50% of baseline:
electrical injury, 25.2 +/- 5.3%; stent, 27.1 +/- 3.6%; balloon, 34.3 +/-
11.6%; P = NS). Furthermore, there were no differences between the animals
with thrombosis or balloon occlusion with respect to changes in
echocardiographic parameters of left ventricular function, aortic pressure,
or heart rate after occlusion. CONCLUSIONS: These data provide evidence
that despite equal magnitudes of jeopardized myocardial mass, acute
ischemia induced by thrombotic coronary occlusion results in a greater
incidence of MVA than does nonthrombotic balloon occlusion. These findings
suggest that the process of intracoronary thrombosis itself exerts
arrhythmogenic effects above and beyond the impact of ischemia on
myocardium induced by coronary occlusion.
ARTICLES
Arrhythmogenic influence of intracoronary thrombosis during acute myocardial ischemia
Department of Medicine, Washington University School of Medicine, St Louis, MO 63198.
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