Circulation, Vol 79, 687-697, Copyright © 1989 by American Heart Association
H Calkins, WL Maughan, HF Weisman, S Sugiura, K Sagawa and JH Levine
In normal isolated, perfused canine ventricles, increased ventricular
volume leads to shortening of refractoriness. To test the hypothesis that
myocardium within an infarction zone is more susceptible to volume- induced
changes in refractoriness than is normal myocardium, we measured
strength-interval curves at low and high end-diastolic volumes at control
and infarcted sites in 14 isolated, blood perfused, canine hearts with
chronic (greater than 25 days) infarctions. In addition, the effect of
volume load on inducing ventricular arrhythmias was studied at one to six
sites in 11 hearts. Differences in refractoriness and inducibility at low
(22 +/- 5 ml) and high (48 +/- 6 ml) end- diastolic volumes were compared.
At control sites, volume load reduced the absolute refractory period from
178 +/- 16.5 to 175 +/- 16.7 msec (p less than 0.05), but no significant
change in the relative refractory period occurred. At infarcted sites, the
change in refractoriness with volume load was greater, and the absolute
refractory period decreased from 171.5 +/- 21 to 160.6 +/- 26.3 msec (p
less than 0.01), and the relative refractory period decreased from 180.1
+/- 22.1 to 169.9 +/- 26 msec (p = 0.05). This differential effect of
volume load on refractoriness led to an increased dispersion of overall
refractoriness at high volume. Infarcted sites showing the largest changes
in refractoriness were characterized by patchy scars extending at least to
the midmyocardium, whereas sites located within areas of transmural scar,
endocardial scar, or rare microfoci of fibrosis showed no increased
sensitivity to volume load. Of eight hearts in which no tachyarrhythmias
were inducible during programmed electrical stimulation at low volume, four
had tachyarrhythmias induced at high volume. Sites of stimulation
associated with a conversion from noninducible to inducible
tachyarrhythmias showed a larger degree of shortening of refractoriness
(change in absolute refractory period: 24.7 +/- 16.5 vs. 3.9 +/- 6.5 msec,
p less than 0.05). These data indicate that volume loading may have
electrophysiologic significance and that it may be of greater functional
importance under pathologic conditions.
ARTICLES
Effect of acute volume load on refractoriness and arrhythmia development in isolated, chronically infarcted canine hearts
Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland.
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