Anatomical origin of pressure-related ventricular ectopic rhythms

Effect of preload and afterload on ventricular arrhythmogenesis

To examine whether it is an increase in preload or afterload that may cause ventricular arrhythmias, the ventricles of 13 anesthetized open-chest dogs were bandaged. Next, metaraminol, an almost pure alpha stimulator, was given, followed by removal of the bandage. The ventricles were then sucked in a plastic cup, which was finally removed. The systolic and diastolic ventricular pressures were measured, and the presence of arrhythmias (ventricular ectopic beats or ventricular tachycardia) was observed. Banding the ventricles caused a significant diminution of systolic pressure (-42 +/- 38.0 mmHg; mean +/- SD) and a rise in diastolic pressure (+3.5 +/- 3.7), starting from control values of 126 +/- 36/6.5 +/- 3.0, but no arrhythmia. Metaraminol raised both pressures (+122 +/- 58 and +9.0 +/- 10.3) and caused ventricular arrhythmias in 6 of 13 experiments. Removing the bandage further increased the systolic pressure (+45 +/- 42) and reduced the diastolic pressure (-7.2 +/- 10.3), but made the arrhythmia worse in 10 of 13 experiments. Suction reduced both pressures (-166 +/- 96 and -5.4 +/- 14) and stopped all arrhythmias. Removing the cup increased both pressures (+133 +/- 68 and +15.5 +/- 15.3, respectively) and worsened the arrhythmia in seven of eight experiments. In general, deterioration of ventricular arrhythmias was observed in 23 of 25 maneuvers with either an increase or no change in systolic pressure, but in none of the maneuvers was there a decrease (P < .0001) in systolic pressure.(ABSTRACT TRUNCATED AT 250 WORDS)