Survival of subendocardial Purkinje fibers after extensive myocardial infarction in dogs

The role of antiarrhythmic drugs in sudden cardiac death

Antiarrhythmic drugs may either decrease or increase the likelihood of ventricular fibrillation. Although reliable data suggest reasonable mechanisms for the antiarrhythmic action of several drugs, much less information is available to indicate the mechanisms by which drugs are arrhythmogenic. Antiarrhythmic action may result from suppression of precipitating events such as inappropriately timed premature impulses or runs of excessively rapid impulses and from modification of the conditions predisposing to random reentry. Increases in the likelihood of fibrillation may result from opposite effects on precipitating events or from drug-induced increase in the likelihood of random reentry. One factor that very likely is involved in the latter is the presence of local differences in the electrical activity of myocardial cells that cause significant local differences in the tonic and use-dependent actions of antiarrhythmic drugs.

Serial production of controlled periods of temporary heart block used to unmask and assess latent ventricular automaticity during experimental acute myocardial ischemia

This study examined the onset, time course of development and response to overdrive stimulation of ventricular tachycardia in 10 dogs that underwent a Harris two-stage ligation of the left anterior descending coronary artery. Transient (12 +/- 3 minutes) complete atrioventricular (AV) block was produced 2, 3, 4, 5, 8, 12, 16, 20 and 24 hours after onset of infarction through selective injection of physostigmine salicylate into the AV node artery. Seven of the 10 dogs had early transient arrhythmic episodes that occurred within 20 to 40 minutes after coronary occlusion but none of the dogs had any spontaneous ventricular tachycardia in the ensuing 2 hours. Two hours after left anterior descending coronary artery ligation, complete AV block unmasked in every dog a slow (37 +/- 9 beats/min) AV junctional rhythm readily suppressed by overdrive. Three hours after coronary ligation, AV block revealed a monomorphic ventricular tachycardia (106 +/- 10 beats/min) in 3 of the 10 dogs. Four and five hours after coronary ligation, five and eight dogs, respectively, had ventricular tachycardia during AV block and in three the tachycardia was polymorphic. The two remaining dogs did not develop ventricular tachycardia during the 24 hours of observation. Ventricular tachycardia always began abruptly, first with brief and then longer bursts. Soon after onset the rate of tachycardia began to increase to reach a plateau 2 to 3 hours later at frequencies 21 +/- 9% greater than the initial tachycardia rate. Concomitant with this increase in rate there was a steady decline of overdrive suppressibility and during the plateau phase there was little or no overdrive suppression.(ABSTRACT TRUNCATED AT 250 WORDS)

Electrophysiological effects of tocainide on canine subendocardial Purkinje fibers surviving infarction

The effects of 10 and 20 mg/l of tocainide on transmembrane action potential characteristics were examined in Purkinje fibers surviving infarction. Infarcted tissue was obtained from canine hearts 24 h after coronary artery ligation. The preparation was stimulated at basic cycle lengths (BCL) of 1000-300 ms. Tocainide reduced the overshoot and amplitude of Purkinje fibers surviving infarction. The maximum upstroke velocity (Vmax) was decreased by tocainide in a dose dependent manner. This effect was more prominent at the shorter BCL. Statistical analysis revealed a significant interaction of the BCL with the drug effect on overshoot, amplitude, Vmax and action potential durations (APD50% and APD90%). Tocainide reduced the effective refractory period (ERP) at the BCL of 1000 ms, but had no significant effect at the BCL of 300 ms. Membrane responsiveness and steady state characteristics of Vmax were shifted significantly to more negative membrane potentials by tocainide. Investigation of the recovery kinetics of Vmax in the presence of tocainide showed an exponential recovery of Vmax with a time constant of 514 ms. These results support the finding that the effect of tocainide on Vmax and conductions is enhanced at faster rates of stimulation. Thus tocainide may be able to depress conduction to produce bidirectional block in the termination of ventricular tachycardia caused by reentry, while having minimal effect on conduction at normal heart rates.

Effects of collateral circulation on electrophysiological properties during the acute phase of canine myocardial infarction

To investigate the effect of collateral circulation on the electrophysiological properties of the acutely ischemic myocardium, acute myocardial infarction was produced in the canine heart by coronary artery occlusion alone, and by coronary artery occlusion plus embolization with vinyl latex. Multiple bipolar electrodes for stimulation or for recording electrograms were placed on the subepicardial layer and the subendocardial layer to examine the time course of changes in excitability threshold, effective refractory period, and conduction time. Soon after coronary occlusion plus embolization, electrophysiological properties of the ischemic subepicardium became severely and almost uniformly damaged and showed no recognizable recovery of electrical activities, whereas transient deterioration and subsequent recovery of the electrophysiological properties were observed after coronary occlusion alone. On the other hand, the subendocardium was much less affected electrophysiologically by either coronary occlusion alone or coronary occlusion plus embolization. These results indicate that collateral circulation plays an important role in the recovery from electrophysiological abnormalities in the ischemic subepicardium caused by acute myocardial ischemia, but has little effect on the electrophysiological properties of the ischemic subendocardium.

Coronary venous retroinfusion of procainamide: a new approach for the management of spontaneous and inducible sustained ventricular tachycardia during myocardial infarction

The efficacy of retrograde coronary venous delivery of procainamide for the management of spontaneous and inducible sustained ventricular tachycardia was evaluated and compared with systemic intravenous procainamide administration in 22 conscious dogs with permanent left anterior descending coronary artery occlusion. Selective retrograde injection of procainamide was achieved through an autoinflatable balloon catheter placed in the great cardiac vein, with the tip positioned in the vicinity of the site of left anterior descending coronary occlusion. Great cardiac vein retroinfusion of procainamide was significantly (p less than 0.05) more effective than systemic intravenous injection against spontaneous ventricular tachycardia 1 day after coronary artery occlusion (13 dogs) and against electrically induced sustained ventricular tachycardia in the 3 to 12 day postocclusion period (9 dogs). Significantly lower doses of procainamide were used with retroinfusion as compared with systemic administration, that is, 19.6 +/- 8.8 versus 35 +/- 0 mg/kg body weight during spontaneous tachycardia and 13.4 +/- 4.1 versus 32.1 +/- 2 mg/kg during induced tachycardia (p less than 0.01). Retroinfusion of saline solution through the great cardiac vein had no effect on either type of tachycardia. Myocardial tissue procainamide levels measured in infarcted and ischemic zones of the left anterior ventricular wall were 9 to 100 times higher after great cardiac vein retroinfusion than after systemic injection. Great cardiac vein dye injection studies demonstrated a preferential distribution in left ventricular regions supplied by the occluded coronary artery. It is concluded that regional coronary venous procainamide retroinfusion in dogs with myocardial infarction is more effective than systemic intravenous injection against both spontaneous and inducible sustained ventricular tachycardia. The greater efficacy of great cardiac vein treatment appears to be primarily related to selectively increased delivery of procainamide to ischemic myocardial sites.

Regional changes in intracellular potassium and sodium activity after healing of experimental myocardial infarction in cats

After healing of experimental myocardial infarction in cat hearts, endocardial cells demonstrate persistent regional electrical changes. These include long action potential duration in surviving cells over the infarct scar, and short action potential duration and low membrane potential in border zone cells between the scar and normal tissue. We studied the basis for these electrophysiological changes by measuring intracellular potassium and sodium activity with ion-sensitive microelectrodes in normal, border, and infarct zone cells of the cat left ventricle 2-6 months after ligation of multiple distal tributaries of the left anterior descending and circumflex coronary arteries. In normal zone cells, intracellular potassium activity was 89.6 +/- 12.3 mM (mean +/- SD, n = 9), and sodium activity was 10.8 +/- 2.2 mM (n = 5). Neither was significantly different from infarct zone cells (91.2 +/- 15.0 and 10.5 +/- 3.0 mM, respectively). In contrast, border zone cells had significantly reduced intracellular potassium activity (71.4 +/- 5.1 mM, P less than 0.01, compared to normal and infarct zone cells) and increased intracellular sodium activity (19.1 +/- 5.9 mM, P less than 0.05, compared to normal and infarct zone cells). The membrane potential in border zone cells was more positive to calculated potassium equilibrium potential, and less sensitive to the change in the extracellular potassium concentration in the range between 2 and 10 mM, compared to normal and infarct zone cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Arrhythmia susceptibility and myocardial composition in diabetes. Influence of physical conditioning

Abnormal myocardial composition in diabetes mellitus has been described, but the effects on ventricular vulnerability have not been defined. We have assessed the susceptibility to arrhythmias in a canine model after 1 yr of mild diabetes induced by alloxan. Since physical conditioning can affect metabolic abnormalities in diabetes, this intervention has also been evaluated. Group 1 served as controls and groups 3 and 4 were diabetic. Animals in the latter group as well as nondiabetic controls of group 2 were exercised on a treadmill for the last 8 mo of the experiment. After 1 yr, anesthesia was induced with chloralose for vulnerability studies. The ventricular fibrillation threshold of 24.4 +/- 1.9 mA in group 3 was significantly less than in normals (45.1 +/- 2.2). Spontaneous arrhythmias were also more prevalent in diabetics during acute ischemia (group 3-A). Increased ventricular vulnerability after epinephrine infusion was present in the sedentary diabetes despite normal ventricular function responsiveness. In a superfused preparation of myocardium, resting membrane potential and action potential amplitude were normal in diabetics, and beta-adrenergic stimulation shortened repolarization more than in controls. Myocardial collagen concentrations, which included an interfibrillar distribution on morphologic examination, were increased in group 3. In the trained diabetics of group 4 the basal vulnerability thresholds and responses to epinephrine were normal. While myocardial collagen levels were normal, cholesterol and triglyceride increments persisted. Thus, in mild experimental diabetes, enhanced susceptibility to arrhythmias exists; this susceptibility may be based on a combination of nonhomogenous collagen accumulation affecting local conduction and increased electrophysiologic sensitivity to catecholamines.

Autonomic control of ventricular tachycardia: sympathetic neural influence on spontaneous tachycardia 24 hours after coronary occlusion

This study was performed to determine whether sympathetic nerves influence the rate of ventricular tachycardia occurring spontaneously in dogs 24 hr after occlusion of the anterior descending coronary artery. Seventeen chloralose-anesthetized dogs underwent activation mapping during spontaneous ventricular tachycardia with QRS morphologies similar to those recorded in the conscious state. Bilateral stellate ganglionectomy (n = 8) decreased mean arterial pressure from 71 +/- 4 (mean +/- SE) to 52 +/- 5 mm Hg (p less than .001) and heart rate from 121 +/- 9 to 79 +/- 15 beats/min (p less than .025) by decreasing the number of complexes of ventricular tachycardia from 120 +/- 9 to 49 +/- 15 per minute (p less than .001). Subsequent unilateral sympathetic nerve stimulation (n = 4) was shown to accelerate ventricular tachycardia foci originating from the ipsilateral aspect of the infarction. Regional sympathetic denervation (n = 7) was performed by application of phenol to the epicardium surrounding an electrode at the site of origin of at least one morphology of ventricular tachycardia. Mean arterial pressure did not change, but total heart rate decreased from 122 +/- 9 to 106 +/- 9 beats/min (p less than .01) and the number of complexes of ventricular tachycardia with a morphology arising from the phenol-treated area fell from 68 +/- 12 to 28 +/- 9 (p less than .001). Evidence for regional denervation was documented by prolongation of duration of electrograms and local repolarization times limited to the phenol-treated area. We conclude that sympathetic nerves directly control rate of spontaneous ventricular tachycardia 24 hr after myocardial infarction in the dog.

Electrophysiologic and anatomic basis for fractionated electrograms recorded from healed myocardial infarcts

The electrophysiologic and anatomic basis for fractionated electrograms were investigated in superfused epicardial preparations from infarcted canine hearts. Fractionated bipolar electrograms were frequently recorded in preparations from infarcts 2 weeks to 18 months old but only rarely in preparations from 5-day-old infarcts. The fractionated electrograms were not caused by movement artifacts. They were not associated with depressed transmembrane resting or action potentials (which were found in the 5-day-old infarcts), but rather transmembrane potentials recorded in the vicinity of the bipolar electrodes were normal. Despite the normal transmembrane potentials, activation time in regions where fractionated electrograms occurred was prolonged. However, prolonged activation time by itself did not cause fractionation, since fractionated electrograms were not recorded from normal preparations in which conduction was markedly slowed by a superfusate containing 16 mM potassium and epinephrine. Unipolar electrograms recorded with glass microelectrodes (tip size 1 to 5 microns) showed that activation in regions where fractionated electrograms were recorded was inhomogeneous. Prepotentials were found preceding the upstrokes of some action potentials in regions where double potentials were recorded, suggesting the possibility of electrotonic transmission across high resistance or inexcitable gaps, but no electrotonic potentials were seen in regions with multicomponent fractionated electrograms. Fractionated electrograms were recorded in regions where infarct healing caused wide separation of individual myocardial fibers while distorting their orientation. The anatomic changes probably caused slow and inhomogeneous activation.

Myocardial infarction in the guinea pig: cellular electrophysiology

The cellular electrophysiology of left ventricular preparations from guinea pig hearts was studied 1 hour, 24 hours, and 4-6 weeks after myocardial infarction produced by 6-8 single ties of the distal left coronary artery system or after sham operation. Microelectrode recordings were used to monitor cells from the endocardial surface of each preparation in tissue bath. All coronary ligated preparations displayed accelerated spontaneous activity compared to normal and sham operated preparations. Single and multiple premature ventricular depolarizations occurred frequently in coronary ligated and rarely in normal and sham operated preparations. Premature stimuli delivered to areas overlying and bordering the area of infarction, induced short bursts of self-terminating rapid repetitive ventricular activity in 4 of 8 (50%) acute (1-hour), 5 of 9 (55%) subacute (24-hour), and 14 of 20 (70%) healed (4-6-week) infarcted preparations. Such activity could not be induced in normal and sham operated preparations. The preparations with healed infarction were unique in that they demonstrated runs of self-terminating repetitive ventricular activity which occurred spontaneously or was inducible with premature stimulation. Recordings from multiple sites in acute, subacute, and healed preparations revealed a variety of transmembrane action potential abnormalities (i.e., reduced action potential amplitude and resting potential, decreased and increased action potential duration, and depressed maximum rates of phase 0 depolarization) in cells overlying and bordering areas of infarction. Only Purkinje fiber action potentials were recorded over the healed infarcts. These data demonstrate that a spectrum of electrophysiological alterations occur in response to ischemic injury and persist after healing of the injury in this new model of myocardial infarction utilizing the guinea pig.

An evaluation of automaticity and triggered activity in the canine heart one to four days after myocardial infarction

Both abnormal automaticity and triggered activity induced by delayed afterdepolarizations have been proposed as the primary mechanism for ventricular tachycardia (VT) occurring in dogs 24 hr after ligation of the left anterior descending coronary artery. Because of this controversy, we studied the effects of ventricular pacing and therapeutic concentrations of lidocaine and ethmozin on sustained rhythmic activity of isolated subendocardial preparations excised from the infarct, and on VT in conscious dogs. There were differences in the sustained rhythmic activity cycle length of isolated preparations and the VT cycle length that were attributable to the absence of sympathetic input in the former and its presence in the latter. In isolated tissues, pacing for 1 or 10 beats reset the sustained rhythmic activity and pacing for 1 min induced overdrive suppression. Lidocaine (5 micrograms/ml) had no effect on sustained rhythmic activity but ethmozin (2 micrograms/ml) suppressed it. Delayed afterdepolarizations occurred but appeared to be induced by pacing or by the hyperpolarization associated with recovery. Although delayed afterdepolarizations were infrequent at 24 hr, their frequency increased with the hyperpolarization of the membrane that occurred at 48 to 96 hr after infarction. Delayed afterdepolarizations also occurred more readily when superfusate temperature was lowered. In conscious dogs, pacing the VT for 1 or 10 beats or 1 min had no effect. Lidocaine (2 to 10 micrograms/ml) did not affect the VT but ethmozin (2 to 5 micrograms/ml) increased VT cycle length significantly. Pacing for 1 min in the presence of ethmozin, but not lidocaine, converted VT to sinus rhythm. Our results suggest that although delayed afterdepolarizations occur at 24 hr after infarction in the standard Harris preparation, they are most readily seen as an accompaniment of hyperpolarization, pacing, or lowering of bath temperature. The predominant rhythm at 24 hr appears to be automatic.

Current status of surgery for ventricular tachyarrhythmias

This article outlines the accepted histopathologic and electrophysiologic theories underlying the etiology of medically refractory ventricular tachyarrhythmias. It delineates the indications and techniques for the electrophysiologic study of the ventricle. Finally, the surgical procedures available as well as their indications and results are elucidated.

Effects of bepridil on transmembrane action potentials recorded from isolated canine cardiac tissues. Studies on normal and infarct-zone Purkinje fibres and ventricular muscle cells

The electrophysiological effects of bepridil (1.9 mumol/l), a drug with antianginal and antiarrhythmic actions, were studied on transmembrane action potentials recorded from isolated cardiac tissues using standard microelectrode techniques. Recordings were made (a) from normal canine cardiac Purkinje fibres in major false tendons, (b) from partially depolarized subendocardial Purkinje fibres in 24 h infarct zones, and (c) from ventricular muscle preparations. It was found that at cycle lengths between 1000 and 300 ms, bepridil exerted use-dependent effects on the maximum rate of depolarization of phase zero (dV/dtmax) and action potential amplitude (APA) in both normal and infarct zone Purkinje fibres (IZPF), but that the effects in the IZPF were relatively greater. Bepridil did not affect maximum diastolic potential (MDP) in normal Purkinje fibres, but decreased it in IZPF. Bepridil lengthened total action potential duration under all conditions, but exerted variable effects on the duration of the plateau (APD-60 mV). In normal ventricular muscle cells (basic cycle length = 1000 ms), bepridil only decreased dV/dtmax. In regard to effects on automatic activity in canine Purkinje fibres, bepridil resembled slow inward current blocking drugs: it did not decrease the rate of normal automaticity or the slope of phase 4 depolarization in normal fibres (with MDPs greater than -80 mV), but it did slow or abolish abnormal automaticity in IZPF (with MDPs less than -60 mV). Bepridil also abolished triggering in 24 h IZPF.

The effects of single premature stimuli on automatic and triggered rhythms in isolated canine Purkinje fibers

We studied the effects of single premature stimuli on automatic and triggered rhythms occurring in preparations of isolated canine Purkinje fibers. Preparations were made from false tendons, the subendocardial right bundle branch, and infarct zone Purkinje fibers 24 hr after occlusion of the left anterior descending coronary artery, and were studied by standard microelectrode techniques. Single premature impulses almost always produced reset of automatic rhythms, whether the pacemaker had a low (less than -60 mV), intermediate (-61 to -70 mV), or high (greater than -70 mV) maximum diastolic potential. In contrast, single premature impulses imposed on triggered rhythms sometimes were found to alter these rhythms; often, early premature impulses (i.e., during phase 3) resulted in either a shortened first return cycle or a short period of arrest of the rhythm. The results of this study indicate that it may be possible to design simple electrophysiologic tests using single premature stimuli to determine whether an arrhythmia is being caused by an automatic focus or by triggered activity.

Development of an endocardial-epicardial gradient of activation rate during electrically induced, sustained ventricular fibrillation in dogs

Electrograms recorded with currently available electrodes become indistinct soon after the onset of ventricular fibrillation (VF), thus, little is known about transmural myocardial depolarization during VF. A plunge electrode system (plunge) was developed that registers discrete deflections during VF. These plunges were used to record for 20 minutes after inducing VF with a single premature shock in 20 open-chest dogs. In the first 6 dogs the epicardium was exposed to room temperature and in 14 dogs transmural temperature was maintained at 38 degrees C. Electrograms recorded with the transmural plunges contained sharp, discrete deflections during early VF in all dogs. Over the next 20 minutes of VF, the rate, regularity of cycle length and discreteness of the deflections in the electrograms decreased with time, first at the epicardial level, then deeper toward the endocardium. In all dogs, however, discrete, regular, rapid deflections persisted in the most subendocardial electrogram throughout the recording period. In 8 dogs, transmural myocardial biopsy samples were taken before fibrillation, and at intervals after the onset of fibrillation. The high-energy phosphate content of the myocardium decreased during VF, with comparable decreases in the epicardial and endocardial halves. Coronary perfusion was maintained during the first 20 minutes of VF in 6 additional dogs by cardiopulmonary bypass. A gradient of activation rates did not develop on bypass, but did develop within 1 minute of halting bypass. Thus, the endocardial-epicardial gradient of activation rates during VF is caused by ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Structural and electrophysiological changes in the epicardial border zone of canine myocardial infarcts during infarct healing

Structural and electrophysiological properties of the epicardial muscle which survives on the surface of transmural infarcts of the canine heart (epicardial border zone) were studied at different times after occlusion of the left anterior coronary artery (LAD). Isolated preparations were superfused in vitro, transmembrane potentials recorded, and impulse propagation mapped. In preparations from subacute infarcts (1 and 5 days), resting potential, action potential amplitude, upstroke velocity, and duration were all significantly reduced. Well-defined directional differences in propagation occurred. Propagation was more rapid in the direction perpendicular to the left anterior coronary artery than in the direction perpendicular to the base of the heart, because of the uniform anisotropic structure of the surviving muscle fibers which were arranged in tightly packed bundles oriented perpendicular to the left anterior coronary artery. The only ultrastructural abnormalities found in these muscle fibers was an accumulation of large amounts of lipid droplets. As the infarcts healed, resting potential, action potential amplitude, and upstroke velocity returned to normal by 2 weeks, although action potential duration decreased further. Lipid droplets had disappeared, and connective tissue had invaded the epicardial border zone, separating the muscle bundles. By 2 months, action potentials were normal, but the muscle fibers were widely separated and disoriented by the connective tissue (parallel bundles no longer were found). In these regions with a nonuniform anisotropic structure, the well-defined directional differences in impulse propagation were lost. However, activation was very slow, perhaps because of diminished connections between cells. The persistence of slow conduction in healed infarcts may contribute to the occurrence of chronic arrhythmias.

Spontaneous ventricular tachycardia associated with isolated right ventricular infarction, one day after right coronary artery occlusion in the dog: studies on the site of origin and mechanism

The electrophysiologic and arrhythmic properties of isolated infarcted right ventricle (RV) were studied in 17 dogs during the first 24 hours after complete occlusion of the right coronary artery (RCA). During the 16-to-20-hour post occlusion period, spontaneously occurring sustained monomorphic ventricular tachycardia (VT) was present in all 17 dogs. Overdrive ventricular pacing (cycle lengths 200 to 250 msec) caused significant suppression of the VT when the rate of the VT was slower than 150 bpm (range 120 to 145 bpm) (n = 9), but had negligible effect when VT rate was higher than 150 bpm (range 160 to 245 bpm (n = 8). Overdrive pacing could not terminate either the slow or the fast type of VT. Bipolar intramural electrograms have showed electrical activity in the infarcted RV zone to precede Q wave of the VT by 15.4 +/- 5.8 msec regardless of VT rate. Microelectrode studies on isolated RV endocardial infarcted tissues 24 hours after RCA occlusions have shown the presence of spontaneous repetitive activity at a rate of 87 +/- 47 bpm, which was overdrive suppressed in dogs with slow VT, and spontaneous activity at a rate of 115.2 +/- 36 bpm (p less than 0.05) which was not overdrive suppressed in dogs with fast VT. Maximum diastolic potential, action potential amplitude, and Vmax of surviving subendocardial Purkinje fibers (SEPF) in the infarct zone were slightly but significantly depressed (p less than 0.05), and they manifested enhanced phase 4 depolarization, giving rise to automatic impulse initiation. Although action potential duration of these fibers was somewhat prolonged (p less than 0.05), no conduction delay occurred. Histopathologic examinations have shown necrosis of the basal two thirds of the RV, with no left ventricular involvement. Electron microscopy revealed lipid accumulation in the surviving SEPF as the sole abnormality. We conclude (1) that occlusion of the RCA in the dog is associated with high survival rate despite extensive necrosis involving exclusively the RV and (2) that VT seen during the 20 to 24 hours after occlusion arise in the infarcted zone of the RV, by an enhanced automatic mechanism in the surviving SEPF, possibly caused by cytoplasmic lipid accumulation. This model, by virtue of its high survival rate and frequency of late VTs, should be useful in providing clues to determine factors involved in the genesis of early VT/VF and for the evaluation of new pharmacologic agents during the 20- to 24-hour VT period.

Postinfarction sudden death: significance of inducible ventricular tachycardia and infarct size in a conscious canine model

The relationship between inducible ventricular tachycardia in the convalescent phase of myocardial infarction and subsequent spontaneous ventricular fibrillation is uncertain. Thirty conscious instrumented dogs underwent programmed ventricular stimulation 5 days after anterior infarction; 15 had inducible ventricular tachycardia and 15 were noninducible. Following programmed ventricular stimulation, the application of a 150 uA current to the intima of the proximal circumflex artery initiated intimal damage, thrombosis, and acute ischemia of the posterolateral wall. After 20 minutes of ischemia, 73% inducible and 15% noninducible animals developed ventricular fibrillation (p less than 0.005) without previous hypotension. At 24 hours, 7% inducible and 85% noninducible animals survived (p less than 0.001). Anterior infarct size (percentage of left ventricular mass) was much larger in inducible (24.7 +/- 1.7%) than in noninducible (5.3 +/- 1.1%) (p less than 0.001) animals. Inducible ventricular tachycardia following infarction was highly predictive of spontaneous ventricular fibrillation during a later ischemic episode in this model. The mass of previously injured myocardium was a critical determinant of both.

Effects of reperfusion on complete heart block complicating anterior myocardial infarction

Two patients with complete heart block complicating extensive anterior myocardial infarction underwent late (greater than 40 hours) coronary reperfusion with angioplasty. One to one atrioventricular conduction was restored within minutes of reperfusion despite a lack of measurable ventricular muscle salvage as demonstrated by ventriculography 1 week later. The evidence favors reversible ischemia rather than extensive necrosis of the proximal conduction system as the mechanism of heart block in this subgroup of patients.

Clinical electrocardiographic studies of bifid T waves

In 129 electrocardiograms from 129 patients showing bifid T waves as well as U waves the intervals from the beginning of the QRS complex to the two T wave apices (QaT1, QaT2), to the end of the T wave (QeT), and to the apex of the U wave (QaU) were measured. Eighty additional electrocardiograms from matched control subjects showing single peaked T waves were also studied. The precordial distribution of bifid T waves was assessed by calculating lead prevalence indices. This index progressively increased from 2.15 in the age range 20-29 years to 3.72 in the age range 60-69 years, and was significantly higher in patients with left ventricular hypertrophy and ischaemia (4.04) than in those with otherwise normal electrocardiograms (2.35). Thus older age and left ventricular pathology were accompanied by a more leftward location of bifid T waves. Exercise accentuated the bifid nature of the T wave in 12 of 18 patients with otherwise normal electrocardiograms, and diminished it in 11 of 19 cases with left ventricular hypertrophy and ischaemia. When 41 otherwise normal tracings showing bifid T waves were compared with those of 42 matched controls showing single peaked T waves, the QTc was longer and the eTaU interval shorter in the group with bifid T waves. Similarly, 40 patients with left ventricular hypertrophy and ischaemia showing bifid T waves had longer QTc and shorter eTaU intervals than 38 patients with the same diagnosis with single peaked T waves. These findings suggest that right precordial bifid T waves in younger patients with otherwise normal electrocardiograms probably result from delayed right ventricular repolarisation, whereas left precordial bifid T waves in older patients with left ventricular hypertrophy and ischaemia may indicate repolarisation delay in the ischaemic left ventricle.

Differential effects of ischaemia and hyperkalaemia on myocardial repolarization and conduction times in the dog

The role of increased extracellular K+ concentration ([K+]o) in the production of the early electrophysiological changes induced by myocardial ischaemia, was evaluated by recordings of monophasic action potentials and the paced endocardial evoked response. Changes in the duration of local repolarization and conduction time were evaluated during ischaemia, K+ infusion and hypoxia. Raising [K+]o levels in systemic arterial blood from 3.4 +/- 0.5 mmol l-1 to 5.9 +/- 1.5 mmol l-1 produced a similar shortening of repolarization as was seen during ischaemia. Prolongation of conduction time occurred only when the [K+]o levels rose to 8.8 +/- 1.3 mmol l-1. The conduction time slowing during acute ischaemia was always greater and occurred at lower [K+]o levels than that produced by K+ infusion at rates equivalent to the post-ischaemic myocardial venous effluent. Monophasic action potential amplitude and upstroke velocity were reduced in ischaemia but not markedly affected by the increase in [K+]o. Absolute reduction in repolarization time during K+ infusion was more marked at the apex than at the base in the epicardial recordings. The superimposition of hypoxia on hyperkalaemia resulted in marked slowing of repolarization and conduction time. Many but not all of the early electrophysiological abnormalities of acute ischaemia in the intact heart can be related to raised [K+]o.

Rationale of therapy in the patient with acute myocardial infarction and life-threatening arrhythmias: a focus on bretylium

Experimental evidence suggests a number of pathologic and electrophysiologic mechanisms that may help initiate ventricular arrhythmias accompanying myocardial ischemia and infarction. Early and late phase events are associated with reentry or an enhancement of focal mechanisms, or both. These can initiate ventricular tachycardia (VT) or ventricular fibrillation (VF), or both. The presence of distinct mechanisms that may initiate and maintain life-threatening dysrhythmias early in myocardial ischemia suggest different pharmacologic approaches for their prevention or suppression. Another consideration concerns patients subjected to coronary artery angioplasty or thrombolytic therapy and the development of arrhythmias associated with reperfusion of the once ischemic myocardium. The electrophysiologic mechanisms associated with reperfusion arrhythmias are unknown, and little is known about appropriate therapy for each episode of cardiac dysrhythmia. Ventricular extrasystoles or VT usually precedes VF. These premonitory arrhythmias are poor criteria for the institution of antiarrhythmic drug therapy, because VF develops within 1 to 10 minutes after the appearance of the rhythmic disturbances. Some authorities suggest that all patients with acute myocardial infarction should receive prophylactic antiarrhythmic therapy, because warning arrhythmias either do not occur at all or provide insufficient time to intervene pharmacologically. Many of the new class I antiarrhythmic agents effectively reduce the frequency of premature ventricular depolarizations, but lack specific antifibrillatory activity. However, the recent introduction of bretylium into clinical cardiology opens a new approach to preventing life-threatening ventricular dysrhythmias. Along with other members of class III, bretylium exerts different cardiac electrophysiologic effects than do the other 3 classes of drugs.(ABSTRACT TRUNCATED AT 250 WORDS)

Electrophysiologic basis for arrhythmias in ischemic heart disease

Substantial gains have been made toward clarifying the mechanisms of arrhythmia in ischemia in animal models. After coronary occlusion in the dog, ischemic myocardial cells have reduced resting potential and slowed and diminished upstrokes of action potentials due to depression of fast channels. As a result, conduction is slow and irregular, especially at shorter cycle lengths, because refractoriness is altered by a delay in recovery of the fast channels beyond the completion of repolarization. These abnormalities occur during the acute phase of arrhythmia in the first half hour after occlusion and persist in surviving the subepicardial layers of myocardial cells for days to weeks. Reentry has been mapped in these surviving layers. Reentrant circuits form around regions of functional block formed by interfaces between responding and refractory myocardium. Standard antiarrhythmic agents generally are fast-channel blockers that further depress conduction and prolong refractoriness in ischemic tissue, causing block in slow conducting segments of the reentry circuits. However, antiarrhythmic agents may cause or accentuate reentrant arrhythmias by virtue of the same depressant actions. The greater likelihood of antiarrhythmic agents suppressing rather than producing reentrant arrhythmias may be due to enhanced depressant effects of antiarrhythmic agents on very slowly conducting tissues that are involved in reentry circuits. After the acute phase, arrhythmias occurring 1 to 4 days after coronary occlusion are probably largely automatic, although the potential for reentry remains if the cycle length is shortened. Abnormally enhanced automaticity and triggered activity are demonstrable in the surviving Purkinje network in regions of infarction, but the role of these phenomena in vivo has not been clarified.(ABSTRACT TRUNCATED AT 250 WORDS)

The relationship between ventricular arrhythmias and ischemia-induced conduction delay in closed-chest animals within 24 hours of myocardial infarction

To investigate the myocardial conduction characteristics of premature impulses during the first 24 hours following coronary ligation and its relationship to late infarction ventricular arrhythmias, transmural electrodes were positioned in the normal and ischemic myocardium in nine dogs. Cardiac conduction in ischemic myocardium was delayed 15 minutes post coronary occlusion both in the epicardium and endocardium, both in the anterograde (base to apex) and retrograde (apex to base) direction, and was maintained at the same level throughout the experiment. Conduction across the border of ischemic myocardium from ischemic to the normal segment was also delayed, especially in the endocardium. Spontaneous ventricular arrhythmias recorded on Holter tapes showed significant increase in the number of premature ventricular complexes and ventricular tachyarrhythmias 9 hours after infarction. Thus our findings suggest that spontaneous arrhythmias occurring in the late phase of acute myocardial infarction (AMI) are independent of the ischemia-induced conduction delay and an alternate mechanism such as abnormal automaticity may be responsible for late ventricular arrhythmias.

Effects of nifedipine on triggered activity in 1-day-old myocardial infarction in dogs

Triggered activity arising from a delayed afterdepolarization occurs in canine subendocardial Purkinje fibers 1 day after myocardial infarction (MI). Standard microelectrode techniques were used to study small preparations (20 to 48 mm2) in vitro. Nifedipine, 1 mg/liter, reversibly suppressed triggered activity by reducing maximum diastolic potential, action potential amplitude and the rate of depolarization of the delayed afterdepolarization. Complete quiescence or exit block resulted. The effects of nifedipine were antagonized by elevating extracellular calcium ion concentration. These results suggest that spontaneous ectopic rhythms 1 day after MI that are the result of triggered activity are dependent on transmembrane calcium ion movement, which nifedipine can directly antagonize.

Epicardial ECG signals following global myocardial ischaemia

Experiments were performed on 10 dog hearts undergone 15 to 90-minute normothermic arrests and 60-minute reperfusion in a special heart-lung model. The purpose of the experiments was to characterize the global ischaemic effects recorded on epicardial electrograms. The duration of QRS complexes and of RR intervals, the integral of ST segment shifts (sigma ST), the number of points showed ST segment displacements (NoST) and the ST segment isopotential map obtained by computer control were evaluated. Only a minor ST segment deviation, a small increase in duration of QRS complexes and of RR intervals with bradycardia and a tendency to electrical stability were found after global ischaemic influences. These observations indicate that pathological electrical manifestations occurring after a global ischaemia are less serious than those occurring after a focal ischaemia.

Electrophysiologic and myocardial metabolic changes in the acute phase of partial coronary occlusion

The acute effects of the partial reduction of coronary blood flow (CBF) on electrical and metabolic changes in myocardium were studied in 59 dogs. In seven dogs with a CBF reduction of 20% to 49%, the adenosine triphosphate (ATP) content (3.59 +/- 0.45 mumol/gm) and the width of the composite electrogram (54 +/- 5 msec) were not significantly different from those of 14 control dogs. In 14 dogs with a CBF reduction of 50% to 74%, ATP decreased significantly (3.09 +/- 0.30 mumol/gm, p less than 0.01); however, widening of the composite electrogram was not noted. Malignant ventricular arrhythmias developed in 5 of 10 dogs with a CBF reduction of 75% to 90% and 6 of 14 dogs with a 100% occlusion, but in none of the dogs with a CBF reduction of less than 75%. Marked widening of the composite electrogram (94 +/- 42 msec, p less than 0.05; and 115 +/- 54 msec, p less than 0.001) and further decrease in ATP (2.49 +/- 0.28 mumol/gm, p less than 0.001; and 2.66 +/- 0.45 mumol/gm, p less than 0.05) were noted in these two groups with a CBF reduction of greater than or equal to 75%. In conclusion, more advanced ischemia was mandatory for electrical derangements than for metabolic deterioration.

Comparison of the direct effects of nifedipine and verapamil on the electrical activity of the sinoatrial and atrioventricular nodes of the rabbit heart

We compared the effects of nifedipine and verapamil on the rabbit sinus and atrioventricular nodes. Both drugs slowed the rate of impulse initiation by sinus node cells. Verapamil exerted a greater negative chronotropic effect at low concentrations, but at higher concentrations verapamil and nifedipine were equipotent. Nifedipine also reduced the amplitude of sinus node action potentials and the Vmax of phase O, effects which are identical to those previously described for verapamil. Both drugs slowed AV nodal conduction and prolonged refractory periods, but verapamil was more potent than nifedipine. Nifedipine reduced the amplitude of AV nodal action potentials and Vmax of phase O the same as verapamil. Nifedipine and verapamil, therefore, have nearly identical direct effects on the nodes. The failure of nifedipine to depress AV nodal conduction in situ and abolish reentrant AV nodal tachycardia is probably a result of the decreased sensitivity of the AV node to nifedipine compared to verapamil.

Anatomic-electrophysiologic basis for the surgical treatment of refractory ischemic ventricular tachycardia

Recently developed surgical procedures for the treatment of refractory ischemic ventricular tachycardia have significantly improved the prognosis of patients experiencing these life-threatening arrhythmias. Ventricular tachyarrhythmias associated with ischemic heart disease most commonly originate from the ischemic border zone of myocardial infarctions, where the non-uniformity of tissue injury is most prominent. The inhomogeneity in tissue injury results in desynchronization of electrical wavefront propagation through the ischemic myocardium, thus providing the milieu necessary for the development of micro-reentrant circuits that give rise to the ventricular tachyarrhythmias. Preoperative and intraoperative electrophysiologic mapping techniques are capable of characterizing and localizing such arrhythmogenic myocardium sufficiently to direct the surgeon in his operative approach to the treatment of the arrhythmia. Surgical options include the encircling endocardial ventriculotomy, the endocardial resection procedure, endocardial cryoablation, and combinations or modifications of these three basic procedures. The use of these procedures has made the previously employed indirect surgical procedures obsolete for the treatment of refractory ischemic ventricular tachyarrhythmias.

Cellular electrophysiologic characteristics of chronically infarcted myocardium in dogs susceptible to sustained ventricular tachyarrhythmias

Standard microelectrode techniques were used to record transmembrane potentials and determine conduction characteristics in regions of mottled infarcts of canine epicardium, 3 to 5 days or 8 to 15 days after left anterior descending coronary artery occlusion and reperfusion. At 3 to 5 days, resting potential, action potential amplitude, maximal rate of depolarization and action potential duration at 30% repolarization were significantly reduced in the infarcted region. Cells on the epicardial surface showed improvement in resting potential, action potential amplitude and rate of depolarization between 3 to 5 days and 8 to 15 days after infarction. In normal noninfarcted tissues, conduction velocity parallel to fiber orientation was 0.54 +/- 0.06 m/s (mean +/- standard deviation). Slow conduction in infarcted regions ranged from 0.015 to 0.2 m/s. Action potentials recorded from slowly conducting regions tended to include cells with more depressed amplitude and rate of depolarization than other cells in infarcted regions; they also had inappropriately depressed overshoot relative to their resting potential. Action potentials in slowly conducting areas where local conduction block occurred were associated with prepotentials and notches on their depolarization and repolarization phases. The prepotentials and notches appeared to be caused by electrotonic interactions resulting from microcircuitous conduction around or across inexcitable areas. These findings demonstrate that areas of slow conduction are heterogenously distributed in the mottled infarct and suggest that disruptions in cell to cell electrical continuity and decreased excitability may contribute to this slow conduction.

Effect of prolonged cold storage on the mechanical activity of rabbit atria

Even after 21 days of cold storage at 2 degrees C, rabbit atria still showed a detectable response only to isoproterenol while other cardiostimulants (norepinephrine, ouabain, anthopleurin-A and nicotine) failed to activate tissues stored up to 14 days. The specific fluorescence of catecholamines disappeared from the tissue after 5 days of cold storage. The maximum decrease in oxygen consumption and tissue catecholamine content was observed after 14 days and a concomitant decrease in tissue ATP content, Na+-K+, Ca2+ and Mg2+-ATPases was nearly maximal after 7 days of cold storage. The cold storage had no apparent effect on the ultrastructures of myocardial cells except a disappearance in glycogen granules.

Reentrant ventricular arrhythmias in the late myocardial infarction period. 9. Electrophysiologic-anatomic correlation of reentrant circuits

We studied isochronal maps of ventricular activation during ventricular arrhythmias induced by programmed premature stimulation in dogs 3-5 days after ligation of the left anterior descending coronary artery. The entire epicardial surface and selective intramural sites were recorded using a computerized multiplexing technique. The electrophysiologic data were correlated with the anatomic characteristics of the infarction. In nine of 17 dogs (55%), the induced ventricular rhythm was due to reentrant activation in the surviving epicardial layer overlying the infarction. The irregular epicardial layer (up to 4 mm thick) had grossly intact myocardial fibers on microscopic examination but showed abnormal electrophysiologic characteristics. The stimulated premature beat that initiated reentry produced a continuous arc of functional conduction block within the surviving epicardial layer. The activation wave front circulated slowly around both ends of the arc of block, rejoined on the distal side of the arc before breaking through the arc to reactivate an area proximal to the block. This resulted in splitting of the initial single arc of block into two arcs. Reentrant activation continued as two synchronous circuits that traveled clockwise around one arc and counterwise around the other. Reentry spontaneously terminated when the leading edge of both reentrant circuits encountered refractory tissue, resulting in the coalescence of the two arcs of block into one. The present study may increase the understanding of the electrophysiologic mechanism of some ventricular repetitive responses and tachyarrhythmias induced by programmed premature stimulation in the clinical laboratory.

Mechanisms of spontaneous and induced ventricular arrhythmias in the 24-hour infarcted dog heart

The incidence and types of ventricular arrhythmias were evaluated in 14 dogs, 24 hours after occlusion of the left anterior descending coronary artery. After induction of anesthesia and left thoracotomy, standard electrocardiographic leads and electrograms from the His bundle and the left ventricular endocardium and epicardium (both infarct and normal zones) were recorded. Spontaneous ventricular tachycardia presumably due to abnormal automaticity was consistently observed (average rate 154 +/- 26 beats/min). These arrhythmias were irregular and multiform. In this same group of dogs 3 ventricular paced beats at rates above 300 beats/min induced rapid and uniform reentrant ventricular tachycardias (average rate 345 +/- 17 beats/min) that were difficult to terminate by premature beats or overdrive pacing. During this sustained ventricular tachycardia, continuous electrical activity was recorded from composite electrodes on the epicardial surface overlying the infarcted zone. Such interectopic activity was not observed during the spontaneous, automatic arrhythmias. Two of the 14 dogs showed only ventricular fibrillation in response to the provocative stimuli. These data confirm previous findings that 24 hours after acute myocardial infarction in the dog heart multiform ventricular rhythms can result from enhanced automaticity. In addition, it was found that ventricular tachycardia can be induced in the same dog heart by a standard ventricular pacing procedure. Continuous electrical activity bridging the interectopic intervals only during the latter tachycardia provides strong evidence for the reentrant basis of these induced arrhythmias. These experimental findings are comparable to the 2 different forms of ventricular arrhythmias described clinically, at the same stage of myocardial infarction. The direct myocardial recordings also provide new insights into the phenomenon of entrainment of tachyarrhythmias by overdrive pacing.

Regional myocardial lidocaine concentration following continuous intravenous infusion early and later after myocardial infarction

The regional concentration of lidocaine using a double constant infusion technique (250 micrograms/kg/min x 15 minutes followed by 35 micrograms/kg/mg/min x 120 minutes) was studied immediately (2 hours) in seven dogs and 24 hours (six dogs) after myocardial infarction. Tissue levels were determined by gas chromatography and related to regional myocardial blood flow as determined by the radioactive microsphere technique in multiple samples. At 2 hours after infarction a significantly higher lidocaine concentration (4.1 +/- 0.42 micrograms/g) was found in zones with greatly reduced blood flow (regional myocardial blood flow less than 0.2 ml/min per g) when compared with that (2.6 +/- 0.19 micrograms/g) in zones with normal blood flow (regional myocardial blood flow greater than 0.8 ml/min per g) (p less than 0.01). In contrast, in the 24 hour model the opposite situation was observed. Although the concentration of lidocaine in the infarct zone was substantial, a significant decline in lidocaine tissue concentration was found in the zones of lowest blood flow (regional myocardial blood flow less than 0.2 ml/min per g) when compared with that in normal zones (1.76 +/- 0.21 versus 3.38 +/- 0.21 micrograms/g, p less than 0.001). In addition, no significant differences in lidocaine concentrations were found between endocardium and epicardium in any of the groups other than those related to regional myocardial blood flow. Thus, with the double constant infusion technique, lidocaine reached normal and ischemic myocardium in concentrations equivalent to therapeutic plasma concentrations, even in lower infarct blood flow zones, with no significant differences between endocardium and epicardium. Of perhaps greater significance, the age of the ischemic insult is an important determinant of lidocaine tissue distribution in infarcted myocardium.

Effects of epinephrine on the electrophysiologic properties of Purkinje fibers surviving myocardial infarction

The electrophysiologic effects of epinephrine on canine subendocardial Purkinje fibers were examined 24 hours after two-stage ligation of the left anterior descending coronary artery. Transmembrane action potential were monitored simultaneously in noninfarcted (NZ) and infarcted (IZ) zones during epinephrine superfusion at 37 degrees C. Epinephrine (10(-8) M to 10(-5) M) induced dose-dependent increases in maximum rate of phase O depolarization (Vmax), action potential amplitude (APA), and maximum diastolic potential (MDP) in both NZ and IZ. Epinephrine consistently shortened effective refractory period (ERP) in both regions No significant change in action potential duration (APD) was noted at either 50% or 90% repolarization. Impulse conduction through the NZ and into the IZ was significantly improved, as indicated by an increased maximum follow-rate in each region at 10(-6) and 10(-5) M epinephrine. The IZ fibers showed a marked hypersensitivity to this agent, in that responses were particularly pronounced in the IZ vs the NZ in terms of both absolute and percentage changes. The effects of epinephrine on Vmax, MDP, APA, and ERP were generally reversed by propranolol, while remaining relatively unaffected by phentolamine, suggesting a beta-adrenergic mechanism. Increased stimulation of ventricular beta-adrenoceptors in the period 16 to 72 hours after myocardial infarction may influence ventricular vulnerability to "late-phase" arrhythmias through nonuniform effects in Purkinje fibers.

Ventricular activation patterns of spontaneous and induced ventricular rhythms in canine one-day-old myocardial infarction. Evidence for focal and reentrant mechanisms

We studied isochronal maps of ventricular activation during spontaneous multiform ventricular rhythms (rates 120-190/min) and pacing-induced ventricular tachyarrhythmias (rate 230-450/min) in dogs 1 day after myocardial infarction. Recordings were obtained from the entire epicardial surface and from selected endocardial and intramural sites utilizing a computerized multiplexing technique. Spontaneous ventricular rhythms had a focal origin from the surviving subendocardial Purkinje network underlying the infarction and showed frequent shift of the pacemaker site. On the other hand, fast ventricular tachyarrhythmias were consistently induced in the same dogs by bursts of rapid ventricular pacing or programmed premature stimulation and had a tendency to degenerate into ventricular fibrillation. Pacing-induced rhythms were due to reentrant activation that developed mainly in the surviving, electrophysiologically abnormal, epicardial layer overlying the infarction. The last stimulated heat that initiated reentry resulted in a continuous arc of functional conduction block and two slowly circulating activation fronts around both ends of the arc of block. The activation fronts rejoined on the distal side of the arc of block before breaking through the arc to reactivate an area proximal to the block. This resulted in splitting of the initial single arc of block into two separate arcs. Reentrant activation subsequently continued as two synchronous circuits which conducted in clockwise and counterclockwise directions, respectively. Reentry spontaneously terminated when the leading edge of both reentrant circuits encountered refractory tissue and failed to advance. The presence of two synchronous circuits was the hallmark of a stable reentrant activation. The development of three or more asynchronous circuits resulted in an activation pattern that was "prefibrillatory." This pattern was seen to develop during pleomorphic ventricular rhythms and ventricular tachycardias of the torsades de pointes type that degenerated into ventricular fibrillation. Ventricular fibrillation was maintained by continuously changing multiple asynchronous circuits. The transition from a stable reentrant activation pattern to that of ventricular fibrillation was probably related to nonhomogeneous shortening of refractoriness in different parts of the myocardium.

Electrophysiologic effects of encainide on acutely ischemic rabbit myocardial cells

The electrophysiologic effects of encainide were determined in normal and acutely ischemic (30 min) rabbit ventricular muscle cells. Encainide (10(-6), 5 X 10(-6) and 10(-5) M) had no effect on resting potential (RP); 10(-6) M encainide reduced overshoot and action potential (AP) amplitude of cells in normal left ventricles and cells in normal areas of ischemic ventricles. Encainide, 5 X 10(-6) M and 10(-5) M, depressed Vmax and prolonged AP duration of normal cells. Surviving cells within ischemic areas displayed AP with reduced RP, overshoot, AP amplitude, Vmax and shortened AP duration. All encainide concentrations reduced overshoot, AP amplitude and Vmax of depressed AP. Encainide's lengthening of AP duration was greater in cells within ischemic areas than in surrounding normal cells. Encainide (10(-6) M) prolonged effective refractory period and often blocked AP in ischemic cells. Encainide also caused depression in membrane responsiveness. Encainide's differential effect upon AP may significantly contribute to its antiarrhythmic activity in ischemic heart disease.

Effects of left atrial enlargement on atrial transmembrane potentials and structure in dogs with mitral valve fibrosis

The effects of left atrial enlargement on atrial cell electrophysiology and structure were studied in dogs with mitral valve fibrosis. Thirteen dogs (Groups I) had left atrial enlargement and intermittent atrial arrhythmias; 10 dogs (Group II) had left atrial enlargement and chronic atrial fibrillation. The resting and action potentials of cells in isolated preparations from the enlarged left atrium were found not to differ from those in the nonenlarged right atrium or in the atrium of control dogs. The resting and action potentials of cells in Group II atria did not differ significantly from those in Group I atria. Some cells (15 percent of the total studied) in the atria of dogs in Groups I and II were inexcitable, but either superfusion with acetylcholine or norepinephrine restored excitability. The structural studies showed that the left atrium of the dogs in Groups I and II had a reduced number of muscle cell layers spanning the wall with an unusually large amount of connective tissue between greatly hypertrophied cells. Very few degenerating cells were seen. Dramatic abnormalities of cell electrophysiology may not be involved in the genesis of arrhythmias in the enlarged canine atrium, and the altered morphologic features of the atrium in these dogs may be important in the genesis of persistent atrial arrhythmias.

Recent advances in antiarrhythmic drug research: studies in chronic canine myocardial infarction-ventricular tachyarrhythmia models

Several chronic canine myocardial infarction-ventricular tachyarrhythmia models are now available for the evaluation of new antiarrhythmic drugs. The available models fulfill many, but not all of the requirements for an ideal chronic arrhythmia model. Sustained arrhythmias can be initiated in these animals using routine methods of programmed pacing. Presumably, the mechanism for these arrhythmias is localized re-entry, similar to that in patients with previous myocardial infarction and chronic coronary artery disease. However, these models are not suitable for determining whether a new drug will abolish spontaneously-occurring ventricular extrasystoles. In addition, these models are of unproven value in the study of acute spontaneously-occurring sudden death, although recently initiated, provocative work may shed further light on this subject. Most importantly, the available models do seem well-suited to the evaluation of new drugs intended for use of chronic coronary artery disease patients at risk for sustained re-entrant ventricular tachycardia or fibrillation. Notably, the results of preliminary electropharmacologic studies in these canine models parallel closely those findings reported in human patients with sustained life-threatening ventricular tachyarrhythmias. Therefore, increased use of these chronic models for new antiarrhythmic drug testing appears promising.

Early electrophysiologic and anatomic alterations in cat ventricular muscle after coronary artery ligation

The effect of coronary artery ligation on electrophysiologic properties of cat ventricular muscle cells was studied. Depression of resting potential, action potential rate of rise and amplitude was observed in infarcted cells, 30 min to 5 days after ligation. Action potential duration was markedly shortened in acute stages (30-120 min) but gradually lengthened to above control by 48 h. Anatomic sequelae included oedema, loss of fibre striation and cellular necrosis.