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Effect of left ventricular systolic pressure increase on ventricular arrhythmogenicity in old canine myocardial
1Third Department of Internal Medicine, Nagasaki University School of Medicine, Japan.
Objective:
The aim was to examine the effect of an increase in left ventricular systolic pressure (LVSP) on ventricular arrhythmogenicity in old canine myocardial infarction.
Methods:
Fourteen mongrel dogs of either sex weighing 11 to 15 kg were used. Studies were performed 28 d after creation of myocardial infarction by ligation of the anterior descending coronary artery. Electrical induction of ventricular arrhythmia and determinations of effective refractory period (ERP) and local intraventricular conduction delay (LIVCD) were performed using the extrastimulus technique with a cycle length of 300 ms in the normal and infarcted zones of the left ventricle. Heterogeneity of ERP (delta ERP) was determined as a difference between the longest and shortest ERP values in each site. LVSP was raised by constriction of the ascending aorta in a stepwise fashion (control, level A, level B).
Results:
Incidence of electrically induced ventricular arrhythmia was increased from 28.6% at control level of LVSP [130.7(SEM 7.3) mm Hg] to 42.9% at level A [190.9(6.0) mm Hg] and to 64.3% (p < 0.05) at level B [243.3(4.0) mm Hg]. delta ERP and LIVCD were greater in the infarct zone than in the normal zone at each level of LVSP (p < 0.001). delta ERP in the infarct zone increased from 18.9(4.3) ms at control level of LVSP to 20.7(6.8) ms at level A, and to 27.1(8.1) ms at level B (p < 0.001). LIVCD in the infarct zone also increased from 22.9(6.2) ms at control level of LVSP to 26.8(4.9) ms at level A (p < 0.001), and to 36.1(6.0) ms at level B (p < 0.001). delta ERP and LIVCD in the normal zone were only slightly raised by increasing the LVSP. delta ERP and LIVCD in the infarct zone were closely correlated with incidence of electrically induced ventricular arrhythmia.
Conclusions:
Increasing the LVSP enhances ventricular arrhythmogenicity and pre-existing electrophysiologic abnormalities of the heart in the presence of old myocardial infarction. Thus a rise in LVSP from any cause in the old myocardial infarction can be a trigger of life threatening ventricular arrhythmias.