Circulation, Vol 77, 1125-1138, Copyright © 1988 by American Heart Association
R Coronel, JW Fiolet, FJ Wilms-Schopman, AF Schaapherder, TA Johnson, LS Gettes and MJ Janse
An experimental approach is described to quantitate inhomogeneity in
extracellular K concentration ([K+]out) in the presence of ischemia and to
relate this inhomogeneity to the electrophysiologic changes. Extracellular
potassium concentration and local direct-current electrograms from the same
sites were measured in isolated perfused pig hearts with the use of
multiple electrodes. Dispersion of [K+]out is described under three
conditions: (1) during regional ischemia in the "central zone" and the
"borderzone", (2) during global ischemia, and (3) during perfusion of the
heart with a high-K perfusate. Inhomogeneity was greatest during regional
ischemia, especially in the borderzone, where generally lower
concentrations were measured. When during regional ischemia the normal zone
was perfused with a high-K perfusate, dispersion in the ischemic borderzone
diminished, and higher concentrations than in the central zone were
measured. During global ischemia inhomogeneity was slightly larger than
during high-K perfusion. Dispersion during the latter was considered due to
experimental error. A decrease in [K+]out during regional ischemia after
the initial increase was closely correlated with electrical recovery of the
electrograms. This decrease occurred earlier in the borderzone than in the
central zone. During ischemia [K+]out was not related to the occurrence of
monophasic electrograms, which are indicative of the absence of local
regenerative responses. For every single electrode position a linear
relationship between TQ depression and [K+]out was found, the slope of
which varied with the position of the electrode. When all sites were taken
together, there was no correlation between TQ depression and [K+]out. We
conclude that: (1) inhomogeneity of K+ is largest in the borderzone, (2)
potassium flows from the ischemic zone into the normal zone, (3) transient
electrical recovery is related to a decrease (after an initial increase) in
[K+]out, which is at least partly due to a flow of K+ toward the normal
zone, (4) monophasic ("block") electrograms can be recorded from
intrinsically excitable tissue, (5) for every single site in the ischemic
region there is a linear relationship between local [K+]out and local TQ
segment depression, and (6) the degree of TQ depression at a particular
site is not a reliable index of the degree of ischemic injury at that site.
ARTICLES
Distribution of extracellular potassium and its relation to electrophysiologic changes during acute myocardial ischemia in the isolated perfused porcine heart
Department of Clinical and Experimental Cardiology, University of Amsterdam, The Netherlands.
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