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犬短QT综合征发生心室颤动的电生理机制研究
引用本文:柳韶华,金奇,张凝,吴琼,罗庆志,林长坚,凌天佑,陈康,潘文麒.犬短QT综合征发生心室颤动的电生理机制研究[J].国际心血管病杂志,2014,41(1):55-57.
作者姓名:柳韶华  金奇  张凝  吴琼  罗庆志  林长坚  凌天佑  陈康  潘文麒
作者单位:柳韶华 (200025,上海交通大学医学院附属瑞金医院心内科); 金奇 (200025,上海交通大学医学院附属瑞金医院心内科); 张凝 (200025,上海交通大学医学院附属瑞金医院心内科); 吴琼 (200025,上海交通大学医学院附属瑞金医院心内科); 罗庆志 (200025,上海交通大学医学院附属瑞金医院心内科); 林长坚 (200025,上海交通大学医学院附属瑞金医院心内科); 凌天佑 (200025,上海交通大学医学院附属瑞金医院心内科); 陈康 (200025,上海交通大学医学院附属瑞金医院心内科); 潘文麒 (200025,上海交通大学医学院附属瑞金医院心内科);
基金项目:NSFC(项目编号:81270260、81070266、81000081)上海市教委高校创新团队发展计划(项目编号:13140903702)上海市科委
摘    要:目的:研究犬短QT综合征模型易发致命性心室颤动的电生理机制.方法:应用吡那地尔建立比格犬短QT综合征模型,利用篮状电极标测左室心内膜心肌电位.比较静脉推注吡那地尔(负荷剂量0.5 mg/kg,维持剂量每小时0.5 mg/kg)前后,QT间期、T波峰末间期(Tp-Te)、心肌细胞复极90%的动作电位(APD90)及激动恢复时间(ARI)、心室颤动周长(VF-CL)等参数的变化. 结果:与基础状态相比,吡那地尔显著缩短窦性心律和300 ms起搏时的QT间期,分别为(264±17) ms对(240±15) ms,P<0.01;(247±7)ms对(229±10) ms,P<0.01.应用吡那地尔后,APD90、ARI和VF-CL均较基础值显著降低,分别为(175±11) ms对(164±11) ms,P<0.01;(156±11) ms对(147±10) ms,P<0.01;(104±9) ms对(95±7)ms,P<0.01.同时,Tp-Te间距较基础状态延长19%,即(35.8±3.4) ms对(44.1±1.4) ms,P<0.01. 结论:不应期缩短和不应期心室跨壁离散度增加可能是吡那地尔诱导短QT综合征并发致命性室性心律失常的电生理基础.

关 键 词:吡那地尔  短QT综合征  心室颤动  电生理学

The electrophysiological mechanism of ventricular fibrillation in a canine model of short QT syndrome
Institution:LIU Shao-hua,JIN Qi,ZHANG Ning,WU Qiong,LUO Qing-zhi,LIN Chang-jian,LING Tian-you( 1.Department of Cardiology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University,Shanghai 200025,China;)
Abstract:Objective:To investigate the electrophysiologic mechanism of life-threatening ventricular fibrillation (VF) in canine with short QT syndrome (SQTs).Methods:SQTs models were established by pinacidil,and a basket catheter including 64 electrodes was inserted into the left ventricle to map the action potential of endocardium.QT interval,action potential duration at 90% repolarization (APD90),activation recovery interval (ARI) and Tpeak-Tend(Tp-Te) interval were measured before and after intravenous administration of pinacidil (loading dosage at 0.5 mg/kg,maintenance dosage at 0.5 mg/kg per hour).Results:Compared with baseline,pinacidil significantly shortened QT interval both at sinus rhythm and at the pacing cycle length of 300 ms,which were(264 ± 17)ms vs (240 ± 15) ms (P<0.01) and (247 ± 7) ms vs (229 ± 10) ms (P<0.01),respectively.Pinacidil led to marked abbreviation of APD90,ARI and VF-CL,which were (175 ± 11) ms vs (164 ± 11) ms (P<0.01),(156 ±11) msvs (147±10) ms (P<0.01) and (104±8) ms vs (94±7) ms (P<0.01).TpTe was significantly increased by 38% after the drug administration,that was (35.8 ± 3.4) ms vs (44.1 ±1.4) ms (P<0.01).Conclusion:Abbreviated effective refractory and increased transmural dispersion of repolarization could be the possible electrophysiological basis of life-threatening ventricular arrhythmias in a canine model of SQTs established by pinacidil.
Keywords:Pinacidil  Short QT syndrome  Ventricular fibrillation  Electrophysiology
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