Abstract:
OBJECTIVES:Although the majority of sudden cardiac arrests occur in patients with ischemic heart disease, the effect of therapeutic hypothermia on arrhythmia susceptibility during acute global ischemia is not well understood. While both ischemia and severe hypothermia are arrhythmogenic, patients undergoing therapeutic hypothermia do not have an increase in arrhythmias, despite the fact that most sudden cardiac arrest occur in the setting of ischemia. We hypothesized that mild hypothermia induced prior to myocardial ischemia and reperfusion will have a beneficial effect on ischemia-related arrhythmia substrates. DESIGN:We developed a model of global ischemia and reperfusion in the canine wedge preparation to study the transmural electrophysiologic effects of ischemia at different temperatures. SETTING:Animal study. SUBJECTS:Male mongrel dogs. INTERVENTIONS:Canine left ventricle wedge preparations at 1) control (36°C) or 2) mild hypothermia, to simulate temperatures used in therapeutic hypothermia (32°C), were subjected to 15 mins of no-flow ischemia and subsequently reperfused. MEASUREMENTS AND MAIN RESULTS:Optical action potentials were recorded spanning the transmural wall of left ventricle. Action potential duration for epicardial, mid-myocardial, and epicardial cells was measured. Transmural dispersion of repolarization and conduction velocity were measured at baseline, during ischemia, and during reperfusion. No difference was seen at baseline for conduction velocity or dispersion of repolarization between groups. Conduction velocity decreased from 0.46 ± 0.02 m/sec to 0.23 ± 0.07 m/sec, and dispersion of repolarization increased from 30 ± 5 msecs to 57 ± 4 msecs in the control group at 15 mins of ischemia. Mild hypothermia attenuated both the ischemia-induced conduction velocity slowing (decreasing from 0.44 ± 0.02 m/sec to 0.35 ± 0.03 m/sec; p = .019) and the ischemia-induced increase in dispersion of repolarization (25 ± 3 msecs to 37 ± 7 msecs; p = .037). Epicardial conduction block was observed in six of seven preparations of the control group, but no preparations in the mild hypothermia group developed conduction block (0/6). CONCLUSIONS:Mild hypothermia attenuated ischemia-induced increase in dispersion of repolarization, conduction slowing, and block, which are known mechanisms of arrhythmogenesis in ischemia. These data suggest that therapeutic hypothermia may decrease arrhythmogenesis during myocardial ischemia.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Piktel JS,Rosenbaum DS,Wilson LDdoi
10.1097/CCM.0b013e31825fd39dsubject
Has Abstractpub_date
2012-11-01 00:00:00pages
2954-9issue
11eissn
0090-3493issn
1530-0293journal_volume
40pub_type
杂志文章abstract:OBJECTIVES:To determine nuclear factor kappa B (NF-kappa B) activation in mononuclear and neutrophils from critically ill patients and to compare NF-kappa B activation with circulating concentrations of interleukin (IL)-6, IL-8, and soluble intercellular adhesion molecule (sICAM)-1. DESIGN:Observational study. SETTIN...
journal_title:Critical care medicine
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abstract::We investigated clinically the differences in respiratory work of patients imposed by three modes of one ventilator: the flow-by system, the demand valve system, and the pressure support system. Inspiratory work using flow-by and pressure support systems was reduced sufficiently when compared to the demand valve syste...
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doi:10.1097/00003246-197507000-00001
更新日期:1975-07-01 00:00:00
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更新日期:1993-02-01 00:00:00
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更新日期:2004-05-01 00:00:00
abstract:OBJECTIVE:To evaluate the effectiveness of lorazepam and midazolam for long-term sedation of critically ill, mechanically ventilated patients. DESIGN:Double-blind, randomized, controlled study. SETTING:Medical intensive care unit in a university teaching hospital. PATIENTS:Sixty-four evaluable adult patients admitte...
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更新日期:1999-08-01 00:00:00
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更新日期:1977-01-01 00:00:00
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doi:10.1097/00003246-199402000-00012
更新日期:1994-02-01 00:00:00
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更新日期:2014-04-01 00:00:00
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更新日期:2008-01-01 00:00:00
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更新日期:2008-07-01 00:00:00
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更新日期:2018-05-01 00:00:00
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更新日期:2018-04-01 00:00:00
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更新日期:2002-11-01 00:00:00
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更新日期:2017-04-01 00:00:00
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2000-06-01 00:00:00
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更新日期:1991-02-01 00:00:00
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更新日期:2014-02-01 00:00:00
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doi:10.1097/CCM.0b013e31825b88ba
更新日期:2012-10-01 00:00:00
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更新日期:1989-03-01 00:00:00
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更新日期:1984-09-01 00:00:00
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更新日期:1991-06-01 00:00:00
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更新日期:2001-01-01 00:00:00
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更新日期:1994-02-01 00:00:00