The 12-lead electrocardiogram(ECG) is still the most used tool in cardiology clinical practice. Considering its easy accessibility, low cost and the information that it provides, it remains the starting point for diag...The 12-lead electrocardiogram(ECG) is still the most used tool in cardiology clinical practice. Considering its easy accessibility, low cost and the information that it provides, it remains the starting point for diagnosis and prognosis. More specifically, its ability to detect prognostic markers for sudden cardiac death due to arrhythmias by identifying specific patterns that express electrical disturbances of the heart muscle, which may predispose to malignant arrhythmias, is universally recognized. Alterations in the ventricular repolarization process, identifiable on a 12-lead ECG, play a role in the genesis of ventricular arrhythmias in different cardiac diseases. The aim of this paper is to focus the attention on a new marker of arrhythmic risk, the early repolarization pattern in order to highlight the prognostic role of the 12-lead ECG.展开更多
Early repolarization is a well-described,common electrocardiographic variant.It was initially felt to be benign,but in the last twenty years a suggested a link between specific types of early repolarization and sudden...Early repolarization is a well-described,common electrocardiographic variant.It was initially felt to be benign,but in the last twenty years a suggested a link between specific types of early repolarization and sudden cardiac death has emerged.This association was has been termed the J wave syndrome and includes both the high risk early repolarization and Brugada ECG patterns.The odds of early repolarization change being associated with poor outcomes are still exceedingly small.Nevertheless,the association of a fairly ubiquitous ECG finding with fatal or near fatal clinical outcomes has raised concern.How can we identify the truly high-risk patients?If a patient has a signifi cant clinical event with a concerning ECG repolarization pattern,what should be done next?The authors of this review present current information regarding the Early Repolarization and Brugada Syndromes and how to proceed with diagnosis,management,and risk stratifi cation when early repolarization change is observed on ECG.展开更多
Early repolarization pattern （ERP） is a common electrocardiographic （ECG） variant, characterized by J point elevation manifested either as QRS slurring （at the transition from the QRS segment to the ST segment） ...Early repolarization pattern （ERP） is a common electrocardiographic （ECG） variant, characterized by J point elevation manifested either as QRS slurring （at the transition from the QRS segment to the ST segment） or notching （a positive deflection inscribed on terminal S wave）, ST-segment elevation with upper concavity and prominent T waves in at least two contiguous leads, The prevalence of ERP in normal population varies from 1% to 13%, depending on the age （predominant in young adults）, the race （highest amongst black oooulation）,展开更多
Early repolarization syndrome(ERS), demonstrated as J-point elevation on an electrocardiograph, was formerly thought to be a benign entity, but the recent studies have demonstrated that it can be linked to a considera...Early repolarization syndrome(ERS), demonstrated as J-point elevation on an electrocardiograph, was formerly thought to be a benign entity, but the recent studies have demonstrated that it can be linked to a considerable risk of life- threatening arrhythmias and sudden cardiac death(SCD). Early repolarization characteristics associated with SCD include high-amplitude J-point elevation, horizontal and/or downslopping ST segments, and inferior and/or lateral leads location. The prevalence of ERS varies between 3% and 24%, depending on age, sex and J-point elevation(0.05 m V vs 0.1 m V) being the main determinants.ERS patients are sporadic and they are at a higher risk of having recurrent cardiac events. Implantable cardioverter-defibrillator implantation and isoproterenol are the suggested therapies in this set of patients. On the other hand, asymptomatic patients with ERS are common and have a better prognosis. The risk stratification in asymptomatic patients with ERS still remains a grey area. This review provides an outline of the up-to-date evidence associated with ERS and the risk of life- threatening arrhythmias. Further prospective studies are required to elucidate the mechanisms of ventricular arrhythmogenesis in patients with ERS.展开更多
Background Both early repolarization and altered heart rate profile are associated with sudden death. In this study, we aimed to demonstrate an association between early repolarization and heart rate profile during ex...Background Both early repolarization and altered heart rate profile are associated with sudden death. In this study, we aimed to demonstrate an association between early repolarization and heart rate profile during exercise.Methods A total of 84 subjects were included in the study. Comparable 44 subjects with early repolarization and 40 subjects with normal electrocardiogram underwent exercise stress testing. Resting heart rate, maximum heart rate, heart rate increment and decrement were analyzed.Results Both groups were comparable for baseline characteristics including resting heart rate. Maximum heart rate, heart rate increment and heart rate decrment of the subjects in early repolarization group had significantly decreased maximum heart rate, heart rate increment and heart rate decrement compared to control group （all P〈0.05）. The lower heart rate increment （〈106 beats/min） and heart rate decrement （〈95 beats/min） were significantly associated with the presence of early repolarization. After adjustment for age and sex, the multiple-adjusted OR of the risk of presence of early repolarization was 2.98 （95% CI 1.21-7.34） （P=0.018） and 7.73 （95% CI 2.84-21.03） （P 〈0.001） for the lower heart rate increment and heart rate decrement compared to higher levels, respectively.Conclusions Subjects with early repolarization have altered heart rate profile during exercise compared to control subjects. This can be related to sudden death.展开更多
The effect of the autonomic nerves on the transmural dispersion of ventricular repolarization in intact canine was investigated. By using the monophasic action potential (MAP) recording technique, monophasic action po...The effect of the autonomic nerves on the transmural dispersion of ventricular repolarization in intact canine was investigated. By using the monophasic action potential (MAP) recording technique, monophasic action potentials (MAPs) of the epicardium (Epi), midmyocardium (Mid) and endocardium (Endo) were recorded simultaneously by specially designed plunge needle electrodes at the left ventricular free wall in 12 open chest dogs. MAPD 90 and transmural dispersion of repolarization among three myocardial layers as well as the incidence of the EAD before autonomic nervous stimulation and during autonomic nervous stimulation were compared. The results showed that the MAPD 90 of Epi, Mid and Endo before autonomic nervous stimulation were 278±11 ms, 316±16 ms and 270±12 ms respectively, the MAPD 90 of Mid was significantly longer than that of Epi or Endo ( P <0.01). MAPD 90 of Epi, Mid and Endo were shortened by 19±4 ms, 45±6 ms, 18±3 ms respectively during sympathetic stimulation. Compared with that of the control, the transmural dispersion of repolarization during sympathetic stimulation was shortened from 44±4 ms to 15±3 ms ( P <0.01), but early afterdepolarizations were elicited in the Mid of 5 dogs (41 %) during sympathetic stimulation. Parasympathetic stimulation did not significantly affect the MAPD 90 in the three layers. It is concluded that there is the transmural dispersion of ventricular repolarization in intact canine. Sympathetic stimulation can reduce transmural dispersion of repolarization, but it can produce early afterdepolarizations in the Mid. Parasympathetic stimulation does not significantly affect the transmural dispersion of ventricular repolarization.展开更多
The effect of the autonomic nerves on the transmural dispersion of ventricular repolarization(TDR)under acute myocardial ischemia in intact canine was investigated.Using the monophasic action potential(MAP)recording t...The effect of the autonomic nerves on the transmural dispersion of ventricular repolarization(TDR)under acute myocardial ischemia in intact canine was investigated.Using the monophasic action potential(MAP)recording technique,MAPs of the epicardium(Epi),midmyocardium(Mid)and endocardium(Endo)were recorded simultaneously by specially designed plunge-needle electrodes at the left ventricular free wall under acute myocardial ischemia in 12 open-chest dogs.MAPD 90 and TDR among three myocardial layers as well as the incidence of the early afterdepolarization(EAD)before autonomic nervous stimulation and during autonomic nervous stimulation were compared.It was found that 10 min after acute myocardial ischemia,TDR was increased from 55±8 ms to 86±15 ms during sympathetic stimulation(P<0.01).The TDR(53±9 ms)during parasympathetic stimulation was not significantly different from that of the control(55±8 ms)(P>0.05).The EAD was elicited in the Mid of 2 dogs(16%)10 min after acute myocardial ischemia,but the EAD were elicited in the Mid of 7 dogs(58%)during sympathetic stimulation(P<0.01).It was concluded that:(1)Sympathetic stimulation can increase the transmural dispersion of repolari-zation and induce early afterdepolarizations in the Mid under acute myocardial ischemia,which provide the opportunity for the ventricular arrhythmia developing;(2)Parasympathetic stimulation has no significant effect on the transmural dispersion of repolarization under myocardial ischemia.展开更多
Objective Background and Objects: Naturally occurring temporal variability of action potentialduration (APD) in isolated myocytes has been noted. Most of the studies have beenfocusing on analyzes of the differences in...Objective Background and Objects: Naturally occurring temporal variability of action potentialduration (APD) in isolated myocytes has been noted. Most of the studies have beenfocusing on analyzes of the differences in ionic channels and currents among theepicardial-, mid-myocardial-(M) and endocardial myocytes, and the rate-dependent (adaptation) characteristics of APD. We have found that the change in APD during achange in frequency of stimulation mostly reflects a change in rate of repolarization at distinct membrane potential levels. We assumed that in the myocytes, there is balancing mechanism, which is constantly adjusting the various ionic currents accommodating to the changing conditions. This intrinsic ability of adaptation is important and may offer some of the consequences of the transmural heterogeneity in adaptation of APD. This adaptive behaviors maybe equally important in maintaining the normal electrophysiological properties and in induction of arrhythmia in a case of error in normal adaptation. Though most studies of Na +/Ca 2+ exchange (NCX) has been emphasized on its reverse activaty during pathyological condition. Our hypothesis is that reverse activaty of NCX also plays an important role in adjusting the repolarization of AP during a physiological condition. A mismatch between action potential (AP) repolarization and relaxation of the contraction can be caused by intracellular Ca 2+ transport abnormalities. Ca 2+ influx via reverse activation of NCX can load the sarcoplasmic recticulum (SR), which has arrhythmogenic effect.Methods We studied the single myocytes from the left ventricle of adult mongrel dogs. During the cell separation, collagenase was perfused through LAD by Langandorff system. We use the patch-clamp system to determinded AP in current clamp mode. Myocyte contraction was imaged by a video camera, shortening of unloaded myocytes was detected by a video edge motion detector, using changes in light intensity at the edges of the myocyte. Results From 60 consecutive recorded APs at a constant 1.0 Hz stimulation under steady state conditions we found there is a variance in the repolarization between 10mV and-40mV. We also found the variance in the APD during the rate adaptation range of repolarization. Fluctuation in the transient may contribute to the APD variability. To test thishypothesis we block the transient by intracellular dialysis with 10 mM EGTA(n=19), this caused a significant reduction in the coefficient variability (CV=SD/mean APD%) from 2.3± 0.8 to 1.3± 0.3 P< 0.01. During a rate change of the stimulation from 0.6 Hz to 1.0 Hz. The AP duration increased from 278±8 msec to 320±9 msec, Mean+SD, n=5, 50 APs, P< 0.05. contraction is accompanied by an after-contraction(A-CON). The relaxation of contraction precedes the repolarization of the AP. We assumed that the enhancement of repolarization and the production of after-contraction can be possibly induced by reverse mode of NCX. Reducing [Na +] o by substitution of 40mM Na + with Li + favors NCX activating the reverse mode, which significantly decreased the dome of the AP from 4.8± 0.3 to -10.6± 1.2mV, P< 0.05, and increased the APD from 330±13 to 368±14 msec. P< 0.05.Conclusions Intracellular calcium transient most likely contributes to the beat-to-beat variance of action potential duration in canine ventricular myocyte. And it attributes to the voltage-dependent switch of NCX mode. Calcium concentration is high inmyocytes during the repolarization, and high intracellular Ca 2+ activates NCX in such a manner, that it generates an inward (positive, depolarizing) current. This current works against the repolarization, it is prolonging it, with other words it increases the duration of the action potential. The magnitude of calcium concentration during repolarization is very much dependent on calcium transport in the SR. The calcium transport in the SR is subject to adrenergic actions, and other physiologic and pathologic regulators. Under pathologic conditions展开更多
Intracellular Ca2＋ and Ca2＋-dependent signaling molecule play an essential role in the genesis of long-QT （LQT） syndrome-related ventricular arrhythmias. The effect of calcium-channel antagonist verapamil on repol...Intracellular Ca2＋ and Ca2＋-dependent signaling molecule play an essential role in the genesis of long-QT （LQT） syndrome-related ventricular arrhythmias. The effect of calcium-channel antagonist verapamil on repolarization heterogeneity of ventricular myocardium was assessed in an in vitro rabbit model of LQT syndrome. By using the monophasic action potential （MAP） recording technique, MAPs of epicardium, mid-myocardium and endocardium were simultaneously recorded by specially designed plunge-needle electrodes across the left ventricular free wall in rabbit hearts purfused by Langendorff method with standard Tyrode＇s solution. Bradycardia was induced by com- plete ablation of atrioventricular node. A catheter was introduced into the right ventricle to pace at the cycle lengths （CLs） of 1500, 1000, and 500 ms, successively. Quinidine （2 μmol/L） prolonged QT interval and ventricular MAP duration （MAPD）, and increased transmural dispersion of repolarization （TDR） in a reverse rate-dependent fashion in isolated rabbit heart. No polymorphic ventricular tachycardias were induced under this condition. The effective free therapeutic plasma concentrations of verapamil （0.01--0.05μmol/L） used in this experiment had no effect on quinidine-induced changes of QT interval, MAPD and TDR. This study demonstrated that, in this model of LQT syndrome, blockade of calcium-channel with verapmil had no effect on quinidine-induced changes of repolatiation heterogeneity of ventricular myocardium.展开更多
目的探讨药物致尖端扭转型室性心动过速(Tdp)的发生机制。方法建立冠状动脉灌注的犬左室心肌楔形组织块模型,同步记录左心室内膜、中层、外膜心肌细胞的动作电位及跨壁心电图,观察不同浓度D-Sotalol对动作电位时间(APD)、QT间期、跨壁...目的探讨药物致尖端扭转型室性心动过速(Tdp)的发生机制。方法建立冠状动脉灌注的犬左室心肌楔形组织块模型,同步记录左心室内膜、中层、外膜心肌细胞的动作电位及跨壁心电图,观察不同浓度D-Sotalol对动作电位时间(APD)、QT间期、跨壁复极离散度(TDR)、早期后除极(EAD)及Tdp发生的影响。结果浓度为0～100μmol/L的D-Sotalol呈剂量依赖性地延长各层细胞APD,尤以中层细胞最为显著(P<0.05),因而增加TDR;D-Sotalol在中层细胞可诱发EAD,触发室性早博并形成跨壁折返导致Tdp。结论 D-Sotalol在中层细胞诱发EAD、R on T室性早博是其致Tdp的始动因子,在TDR增加的基础上形成跨室壁折返是Tdp得以维持的关键。展开更多
文摘The 12-lead electrocardiogram(ECG) is still the most used tool in cardiology clinical practice. Considering its easy accessibility, low cost and the information that it provides, it remains the starting point for diagnosis and prognosis. More specifically, its ability to detect prognostic markers for sudden cardiac death due to arrhythmias by identifying specific patterns that express electrical disturbances of the heart muscle, which may predispose to malignant arrhythmias, is universally recognized. Alterations in the ventricular repolarization process, identifiable on a 12-lead ECG, play a role in the genesis of ventricular arrhythmias in different cardiac diseases. The aim of this paper is to focus the attention on a new marker of arrhythmic risk, the early repolarization pattern in order to highlight the prognostic role of the 12-lead ECG.
文摘Early repolarization is a well-described,common electrocardiographic variant.It was initially felt to be benign,but in the last twenty years a suggested a link between specific types of early repolarization and sudden cardiac death has emerged.This association was has been termed the J wave syndrome and includes both the high risk early repolarization and Brugada ECG patterns.The odds of early repolarization change being associated with poor outcomes are still exceedingly small.Nevertheless,the association of a fairly ubiquitous ECG finding with fatal or near fatal clinical outcomes has raised concern.How can we identify the truly high-risk patients?If a patient has a signifi cant clinical event with a concerning ECG repolarization pattern,what should be done next?The authors of this review present current information regarding the Early Repolarization and Brugada Syndromes and how to proceed with diagnosis,management,and risk stratifi cation when early repolarization change is observed on ECG.
文摘Early repolarization pattern （ERP） is a common electrocardiographic （ECG） variant, characterized by J point elevation manifested either as QRS slurring （at the transition from the QRS segment to the ST segment） or notching （a positive deflection inscribed on terminal S wave）, ST-segment elevation with upper concavity and prominent T waves in at least two contiguous leads, The prevalence of ERP in normal population varies from 1% to 13%, depending on the age （predominant in young adults）, the race （highest amongst black oooulation）,
文摘Early repolarization syndrome(ERS), demonstrated as J-point elevation on an electrocardiograph, was formerly thought to be a benign entity, but the recent studies have demonstrated that it can be linked to a considerable risk of life- threatening arrhythmias and sudden cardiac death(SCD). Early repolarization characteristics associated with SCD include high-amplitude J-point elevation, horizontal and/or downslopping ST segments, and inferior and/or lateral leads location. The prevalence of ERS varies between 3% and 24%, depending on age, sex and J-point elevation(0.05 m V vs 0.1 m V) being the main determinants.ERS patients are sporadic and they are at a higher risk of having recurrent cardiac events. Implantable cardioverter-defibrillator implantation and isoproterenol are the suggested therapies in this set of patients. On the other hand, asymptomatic patients with ERS are common and have a better prognosis. The risk stratification in asymptomatic patients with ERS still remains a grey area. This review provides an outline of the up-to-date evidence associated with ERS and the risk of life- threatening arrhythmias. Further prospective studies are required to elucidate the mechanisms of ventricular arrhythmogenesis in patients with ERS.
文摘Background Both early repolarization and altered heart rate profile are associated with sudden death. In this study, we aimed to demonstrate an association between early repolarization and heart rate profile during exercise.Methods A total of 84 subjects were included in the study. Comparable 44 subjects with early repolarization and 40 subjects with normal electrocardiogram underwent exercise stress testing. Resting heart rate, maximum heart rate, heart rate increment and decrement were analyzed.Results Both groups were comparable for baseline characteristics including resting heart rate. Maximum heart rate, heart rate increment and heart rate decrment of the subjects in early repolarization group had significantly decreased maximum heart rate, heart rate increment and heart rate decrement compared to control group （all P〈0.05）. The lower heart rate increment （〈106 beats/min） and heart rate decrement （〈95 beats/min） were significantly associated with the presence of early repolarization. After adjustment for age and sex, the multiple-adjusted OR of the risk of presence of early repolarization was 2.98 （95% CI 1.21-7.34） （P=0.018） and 7.73 （95% CI 2.84-21.03） （P 〈0.001） for the lower heart rate increment and heart rate decrement compared to higher levels, respectively.Conclusions Subjects with early repolarization have altered heart rate profile during exercise compared to control subjects. This can be related to sudden death.
文摘The effect of the autonomic nerves on the transmural dispersion of ventricular repolarization in intact canine was investigated. By using the monophasic action potential (MAP) recording technique, monophasic action potentials (MAPs) of the epicardium (Epi), midmyocardium (Mid) and endocardium (Endo) were recorded simultaneously by specially designed plunge needle electrodes at the left ventricular free wall in 12 open chest dogs. MAPD 90 and transmural dispersion of repolarization among three myocardial layers as well as the incidence of the EAD before autonomic nervous stimulation and during autonomic nervous stimulation were compared. The results showed that the MAPD 90 of Epi, Mid and Endo before autonomic nervous stimulation were 278±11 ms, 316±16 ms and 270±12 ms respectively, the MAPD 90 of Mid was significantly longer than that of Epi or Endo ( P <0.01). MAPD 90 of Epi, Mid and Endo were shortened by 19±4 ms, 45±6 ms, 18±3 ms respectively during sympathetic stimulation. Compared with that of the control, the transmural dispersion of repolarization during sympathetic stimulation was shortened from 44±4 ms to 15±3 ms ( P <0.01), but early afterdepolarizations were elicited in the Mid of 5 dogs (41 %) during sympathetic stimulation. Parasympathetic stimulation did not significantly affect the MAPD 90 in the three layers. It is concluded that there is the transmural dispersion of ventricular repolarization in intact canine. Sympathetic stimulation can reduce transmural dispersion of repolarization, but it can produce early afterdepolarizations in the Mid. Parasympathetic stimulation does not significantly affect the transmural dispersion of ventricular repolarization.
文摘The effect of the autonomic nerves on the transmural dispersion of ventricular repolarization(TDR)under acute myocardial ischemia in intact canine was investigated.Using the monophasic action potential(MAP)recording technique,MAPs of the epicardium(Epi),midmyocardium(Mid)and endocardium(Endo)were recorded simultaneously by specially designed plunge-needle electrodes at the left ventricular free wall under acute myocardial ischemia in 12 open-chest dogs.MAPD 90 and TDR among three myocardial layers as well as the incidence of the early afterdepolarization(EAD)before autonomic nervous stimulation and during autonomic nervous stimulation were compared.It was found that 10 min after acute myocardial ischemia,TDR was increased from 55±8 ms to 86±15 ms during sympathetic stimulation(P<0.01).The TDR(53±9 ms)during parasympathetic stimulation was not significantly different from that of the control(55±8 ms)(P>0.05).The EAD was elicited in the Mid of 2 dogs(16%)10 min after acute myocardial ischemia,but the EAD were elicited in the Mid of 7 dogs(58%)during sympathetic stimulation(P<0.01).It was concluded that:(1)Sympathetic stimulation can increase the transmural dispersion of repolari-zation and induce early afterdepolarizations in the Mid under acute myocardial ischemia,which provide the opportunity for the ventricular arrhythmia developing;(2)Parasympathetic stimulation has no significant effect on the transmural dispersion of repolarization under myocardial ischemia.
文摘Objective Background and Objects: Naturally occurring temporal variability of action potentialduration (APD) in isolated myocytes has been noted. Most of the studies have beenfocusing on analyzes of the differences in ionic channels and currents among theepicardial-, mid-myocardial-(M) and endocardial myocytes, and the rate-dependent (adaptation) characteristics of APD. We have found that the change in APD during achange in frequency of stimulation mostly reflects a change in rate of repolarization at distinct membrane potential levels. We assumed that in the myocytes, there is balancing mechanism, which is constantly adjusting the various ionic currents accommodating to the changing conditions. This intrinsic ability of adaptation is important and may offer some of the consequences of the transmural heterogeneity in adaptation of APD. This adaptive behaviors maybe equally important in maintaining the normal electrophysiological properties and in induction of arrhythmia in a case of error in normal adaptation. Though most studies of Na +/Ca 2+ exchange (NCX) has been emphasized on its reverse activaty during pathyological condition. Our hypothesis is that reverse activaty of NCX also plays an important role in adjusting the repolarization of AP during a physiological condition. A mismatch between action potential (AP) repolarization and relaxation of the contraction can be caused by intracellular Ca 2+ transport abnormalities. Ca 2+ influx via reverse activation of NCX can load the sarcoplasmic recticulum (SR), which has arrhythmogenic effect.Methods We studied the single myocytes from the left ventricle of adult mongrel dogs. During the cell separation, collagenase was perfused through LAD by Langandorff system. We use the patch-clamp system to determinded AP in current clamp mode. Myocyte contraction was imaged by a video camera, shortening of unloaded myocytes was detected by a video edge motion detector, using changes in light intensity at the edges of the myocyte. Results From 60 consecutive recorded APs at a constant 1.0 Hz stimulation under steady state conditions we found there is a variance in the repolarization between 10mV and-40mV. We also found the variance in the APD during the rate adaptation range of repolarization. Fluctuation in the transient may contribute to the APD variability. To test thishypothesis we block the transient by intracellular dialysis with 10 mM EGTA(n=19), this caused a significant reduction in the coefficient variability (CV=SD/mean APD%) from 2.3± 0.8 to 1.3± 0.3 P< 0.01. During a rate change of the stimulation from 0.6 Hz to 1.0 Hz. The AP duration increased from 278±8 msec to 320±9 msec, Mean+SD, n=5, 50 APs, P< 0.05. contraction is accompanied by an after-contraction(A-CON). The relaxation of contraction precedes the repolarization of the AP. We assumed that the enhancement of repolarization and the production of after-contraction can be possibly induced by reverse mode of NCX. Reducing [Na +] o by substitution of 40mM Na + with Li + favors NCX activating the reverse mode, which significantly decreased the dome of the AP from 4.8± 0.3 to -10.6± 1.2mV, P< 0.05, and increased the APD from 330±13 to 368±14 msec. P< 0.05.Conclusions Intracellular calcium transient most likely contributes to the beat-to-beat variance of action potential duration in canine ventricular myocyte. And it attributes to the voltage-dependent switch of NCX mode. Calcium concentration is high inmyocytes during the repolarization, and high intracellular Ca 2+ activates NCX in such a manner, that it generates an inward (positive, depolarizing) current. This current works against the repolarization, it is prolonging it, with other words it increases the duration of the action potential. The magnitude of calcium concentration during repolarization is very much dependent on calcium transport in the SR. The calcium transport in the SR is subject to adrenergic actions, and other physiologic and pathologic regulators. Under pathologic conditions
基金This project was supported by a grant from the National Natural Sciences Foundation of China (No 30470714)
文摘Intracellular Ca2＋ and Ca2＋-dependent signaling molecule play an essential role in the genesis of long-QT （LQT） syndrome-related ventricular arrhythmias. The effect of calcium-channel antagonist verapamil on repolarization heterogeneity of ventricular myocardium was assessed in an in vitro rabbit model of LQT syndrome. By using the monophasic action potential （MAP） recording technique, MAPs of epicardium, mid-myocardium and endocardium were simultaneously recorded by specially designed plunge-needle electrodes across the left ventricular free wall in rabbit hearts purfused by Langendorff method with standard Tyrode＇s solution. Bradycardia was induced by com- plete ablation of atrioventricular node. A catheter was introduced into the right ventricle to pace at the cycle lengths （CLs） of 1500, 1000, and 500 ms, successively. Quinidine （2 μmol/L） prolonged QT interval and ventricular MAP duration （MAPD）, and increased transmural dispersion of repolarization （TDR） in a reverse rate-dependent fashion in isolated rabbit heart. No polymorphic ventricular tachycardias were induced under this condition. The effective free therapeutic plasma concentrations of verapamil （0.01--0.05μmol/L） used in this experiment had no effect on quinidine-induced changes of QT interval, MAPD and TDR. This study demonstrated that, in this model of LQT syndrome, blockade of calcium-channel with verapmil had no effect on quinidine-induced changes of repolatiation heterogeneity of ventricular myocardium.
文摘目的探讨药物致尖端扭转型室性心动过速(Tdp)的发生机制。方法建立冠状动脉灌注的犬左室心肌楔形组织块模型,同步记录左心室内膜、中层、外膜心肌细胞的动作电位及跨壁心电图,观察不同浓度D-Sotalol对动作电位时间(APD)、QT间期、跨壁复极离散度(TDR)、早期后除极(EAD)及Tdp发生的影响。结果浓度为0～100μmol/L的D-Sotalol呈剂量依赖性地延长各层细胞APD,尤以中层细胞最为显著(P<0.05),因而增加TDR;D-Sotalol在中层细胞可诱发EAD,触发室性早博并形成跨壁折返导致Tdp。结论 D-Sotalol在中层细胞诱发EAD、R on T室性早博是其致Tdp的始动因子,在TDR增加的基础上形成跨室壁折返是Tdp得以维持的关键。
