Circulation, Vol 67, 420-425, Copyright © 1983 by American Heart Association
BA Jones-Collins and RE Patterson
Reperfusion achieved by streptokinase infusion early after myocardial
infarction (MI) is now being performed in patients, but the effect on
electrical instability of increasing or decreasing perfusion in the region
at risk for MI is unknown. Accordingly, 34 dogs were randomized to control
(13 dogs), reperfusion (11 dogs) and retrograde bleeding (10 dogs) groups.
All dogs underwent coronary artery occlusion (23 of the left anterior
descending and 11 of the circumflex artery). In the control dogs, occlusion
was permanent. In the reperfused dogs, the occlusion was released at 2
hours. In the retrograde bleeding dogs, retrograde flow bleeding distal to
the occlusive tie was continued for 2 hours after coronary occlusion. Four
days later, all dogs underwent a standard right ventricular pacing
protocol. Induced arrhythmias were scored; ventricular fibrillation was
assigned the highest score, followed by sustained ventricular tachycardia,
nonsustained ventricular tachycardia and repetitive ventricular response.
Arrhythmias provocable later in diastole were assigned higher scores than
those provocable early in diastole. Infarct size was not different in the
three groups (35%, 28% and 39% of the area at risk in control, reperfusion
and retrograde bleeding groups, respectively). However, the electrical
instability index was lower in the reperfusion group than in the other two
groups (e.g., electrical instability index A at 200 beats/min: p less than
0.005 for reperfusion vs control; p less than 0.01 for reperfusion vs
retrograde bleeding). Retrograde bleeding did not alter the electrical
instability index from the control state. These results suggest that
despite no significant reduction in infarct size, reperfusion after
infarction may reduce electrical instability.
ARTICLES
The effects of reperfusion and retrograde coronary flow bleeding after coronary occlusion on induced electrical instability in the dog
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