Circulation, Vol 85, 1464-1472, Copyright © 1992 by American Heart Association
U del Balzo and MR Rosen
BACKGROUND. Cardiac "memory" refers to changes in T wave polarity induced
by ventricular pacing that persist long after resumption of normal
atrioventricular conduction. METHODS AND RESULTS. We studied the occurrence
and mechanism of T wave changes in the open-chest anesthetized dog
subjected to three discontinuous 20-minute periods of right ventricular
pacing. ECG changes were recorded in the standard limb leads during normal
conduction (prepacing) and three trains (T1, T2, and T3) of right
ventricular pacing at a rate 50% higher than normal (pacing), each followed
by a period of normal conduction (postpacing) lasting as long as necessary
for T wave changes to return to control values. During each of these
phases, heart rate, QRS, corrected QT (QTc) duration, and T wave amplitude
were measured. In the first group (control), T wave inversions occurred
during normal atrioventricular conduction after a period of right
ventricular pacing. These T wave anomalies appeared in the absence of any
change in heart rate, QRS, or QTc duration. The magnitude of the T wave
amplitude change was significantly greater after each successive pacing
period. Furthermore, the changes in T wave morphology persisted for a
longer period after each successive pacing train. In a second experimental
group, lidocaine, which depresses the sodium window current, was
administered to six dogs that were subjected to the same pacing protocol.
Lidocaine decreased the QTc interval and prolonged QRS duration but did not
alter the magnitude of changes in T wave amplitude and time to recovery
described in control animals during the three postpacing intervals. In
contrast, in the third group, 4-aminopyridine, a drug that blocks the
transient outward current (ito), abolished the changes in T wave morphology
that occurred during any postpacing interval. CONCLUSIONS. These results
demonstrate that the manifestation of cardiac memory in the in situ dog
heart is not altered by lidocaine but is abolished by 4-aminopyridine.
Thus, cardiac memory may be based on a physiological property of the
myocardium that is related to specific K+ channels.
ARTICLES
T wave changes persisting after ventricular pacing in canine heart are altered by 4-aminopyridine but not by lidocaine. Implications with respect to phenomenon of cardiac 'memory'
Department of Pharmacology, Columbia University, New York, NY 10032.
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