Mechanisms of ventricular arrhythmias associated with myocardial infarction
The American Journal of CardiologyPublished 1 December 1969
Jaok Han
Citations213
SJR quartileQ2
SJR score0.93
SNIP0.73
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
It was concluded that the artificial pacing of the heart at relatively rapid rates is a valuable adjunct to the measures used in the management of ventricular arrhythmias associated with acute myocardial infarction.
Abstract
Ventricular ectopic beats may be generated during acute myocardial infarction as the result of enhanced automaticity in the His-Purkinje system, focal reexcitation due to the flow of current between myocardial fibers which are repolarized at disparate times, or reentry of the impulse induced by local impairment of excitability and conductivity in the ventricular tissues. The ectopic beats occur more frequently when the basic ventricular rate is slow, and the danger of fatal episodes of ventricular fibrillation is also increased at slow ventricular rates. Fibrillation is more likely to be induced by early ectopic beats in the ventricle during myocardial infarction, because the development of sustained ectopic activity and turbulent impulse propagation is facilitated by increased inhomogeneity of the ventricular tissues with respect to excitability and conductivity. The aggressive prevention and treatment of ventricular ectopic beats and bradyarrhythmia was emphasized as one of the most effective means of preventing life-threatening ventricular fibrillation and lowering mortality rates from acute myocardial infarction. The mechanisms of action of various drugs and the efficacy of increased ventricular rates in suppressing ectopic activity were discussed. It was concluded that the artificial pacing of the heart at relatively rapid rates is a valuable adjunct to the measures used in the management of ventricular arrhythmias associated with acute myocardial infarction.
Keywords
Medicine
Annals of Internal MedicineElectrophysiology of the Heart.
1,320 Citations1960
The graphic registration which forms the basis for many illustrations is of less than optimal quality, and many useful techniques, such as left heart catheterization, the analysis of the central arterial pulse, direct oximetry, and differential dye analysis, are entirely omitted.
Circulation ResearchNonuniform Recovery of Excitability in Ventricular Muscle
945 Citations1964Jaok Han, Gordon K. Moe
The degree of dispersion following a basic beat was increased by stimulation of the cardiac sympathetic nerves, administration of chloroform, ouabain intoxication, and administration of higher doses of quinidine, myocardial ischemia, and hypothermia, but it was decreased by administration of sympathomimetic amines.
American Heart JournalAtrial fibrillation as a self-sustaining arrhythmia independent of focal discharge
885 Citations1959Gordon K. Moe, J.A. Abildskov
JAMAThe Coronary Care Unit
541 Citations1967Bernard Lown
In the past two decades there have been momentous advances in the care of patients with cardiovascular ailments, yet, mortality from coronary-artery disease has remained unaffected, with 65% of deaths occurring in the initial three days and 85% during the first week of attack.
New England Journal of MedicineThe Coronary-Care Unit
467 Citations1968Thomas P. Hackett, Ned H. Cassem +1 more
The study from which this last term developed was conducted on postcardiotomy patients in the setting of the recovery room, and there has been a growing tendency to apply it to all situations of intensive care.
American Heart JournalTemporal dispersion of recovery of excitability in atrium and ventricle as a function of heart rate
394 Citations1966Jaok Han, David Millet +2 more
It was concluded that spontaneous closely coupled beats occurring at slow ventricular rates in A-V dissociation may result from asynchrony in the repolarization of adjacent excitable units.
Circulation ResearchAdrenergic Effects on Ventricular Vulnerability
381 Citations1964Jaok Han, P. García de Jalon +1 more
Temporal dispersion of recovery of excitability and the degree of ventricular vulnerability were closely related; the ventricle was more vulnerable to fibrillation when the dispersion was increased.
The American Journal of CardiologyUnresolved problems in coronary care
286 Citations1967Bernard Lown, Carlos Vassaux +4 more
It appears that careful application of coronary care unit policy will result in a one-third reduction in mortality among hospitalized patients with acute myocardial infarction, and evidence is presented to show that aggressive treatment of these disorders should be employed.
Circulation ResearchInterrelationships Between Automaticity and Conduction in Purkinje Fibers
272 Citations1967Donald H. Singer, Ralph Lazzara +1 more
The LancetINCIDENCE, SIGNIFICANCE, AND MANAGEMENT OF EARLY BRADYARRHYTHMIA COMPLICATING ACUTE MYOCARDIAL INFARCTION
246 Citations1968A.A.J. Adgey, J S Geddes +3 more
It is suggested that excessive vagal discharge manifested by bradyarrhythmia is an important precursor of ventricular fibrillation and an important factor in the early high mortality from myocardial infarction.
Circulation ResearchAberrant A-V Impulse Propagation in the Dog Heart: A Study of Functional Bundle Branch Block
244 Citations1965Gordon K. Moe, Carlos F. Méndez +1 more
Excessive delay and configurational change of ventricular responses to atrial premature beats, previously attributed to dissociation within the A-V node, were shown to be due to functional block of the right bundle branch.
Circulation ResearchElectrophysiological Effects of Diphenylhydantoin on Canine Purkinje Fibers
198 Citations1968J. Thomas Bigger, Arthur L. Bassett +1 more
The effects of diphenylhydantoin (DPH) were studied on isolated, perfused Purkinje fibers over a range of concentrations from 10−8 to 10−4 M and caused a decrease in the firing rate of normal automatic fibers by decreasing the slope of phase 4 depolarization.
Circulation ResearchAction of Driving Stimuli from Intrinsic and Extrinsic Sources on in Situ Cardiac Pacemaker Tissues
198 Citations1965G Lange
The interactions between pacemakers, and the effects on pacemaker, of terminating imposed driving were studied in the in situ heart of anesthetized dogs to indicate that mediators are also released in the course of propagated activity.
The Journal of General PhysiologyOn The Mechanism of Spontaneous Impulse Generation in the Pacemaker of the Heart
197 Citations1961W. Trautwein, D G Kassebaum
It is postulated that the mechanism underlying the spontaneous heart beat is a high resting sodium current in pacemaker tissue which acts as the generator of the heart beat when, after a regenerative repolarization, the decrease in potassium conductance during diastole reestablishes the condition of threshold.
American Journal of Physiology-Legacy ContentToxic effects of ouabain on Purkinje fibers and ventricular muscle fibers
190 Citations1962Mario Vassalle, Johannes Karis +1 more
Toxic effects of ouabain on single Purkinje fibers and ventricular muscle fibers were investigated in vitro by microelectrode technique.
The American Journal of CardiologyVentricular vulnerability during acute coronary occlusion
170 Citations1969Jaok Han
It was concluded that reentrant activity and resulting fibrillation are more likely to be induced in the ventricle with an ischemic area because of the increased irregularity in the propagation of premature impulses.
CirculationMechanisms of Intermittent Ventricular Bigeminy
156 Citations1955Richard Langendorf, Albert I. Pick +1 more
Analysis of electrocardiographic material shows a definite relationship between the duration of the ventricular cycle and the occurrence of ventricular premature systoles, in that long cycles favor their appearance whereas short cycles tend to preclude it.
Annals of Internal MedicineTreatment of Ventricular Arrhythmia by Permanent Atrial Pacemaker and Cardiac Sympathectomy
147 Citations1968Douglas P. Zipes, BARRY FESTOFF +4 more
A case of a patient with recurrent paroxysmal ventricular tachycardia fibrillation and the three modes of therapy used to achieve complete suppression of the ectopic ventricle suppression are presented.
Circulation ResearchFibrillation Threshold of Premature Ventricular Responses
143 Citations1966Jaok Han, Garcia de Jalon +1 more
The observed spatial and temporal relationships suggest that the fibrillation threshold is related inversely to the degree of asymmetry in the excitable field.
Pflügers Archiv - European Journal of PhysiologyAutomatie-f�rdernde Dehnungseffekte an Purkinje-F�den, Papillarmuskeln und Vorhoftrabekeln von Rhesus-Affen
133 Citations1967R. Kaufmann, U. Theophile
American Heart JournalIncidence of ectopic beats as a function of basic rate in the ventricle
132 Citations1966Jaok Han, John DeTraglia +2 more
The frequency of development of ventricular ectopic beats was studied at different basic frequencies under conditions which facilitate the induction of ectopy beats and fibrillation in the ventricle to emphasize the importance of selection of an optimum rate of stimulation.
Circulation ResearchThe Effect of Complete Ischemia on the Intracellular Electrical Activity of the Whole Mammalian Heart
99 Citations1958Milton Kardesch, CHARLES E. HOGANCAMP +1 more
Spontaneous ventricular electrical potentials of whole mammalian hearts subjected to complete ischemia were investigated by means of the intracellular microelectrode and the relationship of these effects to change in membrane ionic transports and metabolic processes are discussed.
CirculationThe Action of Several Cardiac Glycosides on Conduction Velocity and Ventricular Excitability in the Dog Heart
96 Citations1951Gordon K. Moe, R Méndez
Conduction, while depressed in the specialized tissue, was well maintained in the muscle itself until death of the heart.
Progress in Cardiovascular DiseasesThe genesis of cardiac arrhythmias
90 Citations1966Brian F. Hoffman
The general mechanisms to be described may provide a framework on which studies of clinical arrhythmias can be based and that such studies ultimately will provide the desired understanding of specific mechanisms.
Annals of Internal MedicineTransvenous Atrial Pacing in the Treatment of Refractory Ventricular Irritability
89 Citations1967John A. Kastor, ROMAN W. DESANCTIS +2 more
Excerpt Among the most challenging and potentially fatal problems in medicine is that of repetitive ventricular tachycardia and ventricular fibrillation that cannot be suppressed with the usual anticoagulant treatment.
CirculationPrevention of Ventricular Tachycardia and Fibrillation by Intravenous Isoproterenol and Epinephrine
84 Citations1963Arthur J. Linenthal, Paul M. Zoll
Isoproterenol and epinephrine were given intravenously in dilute solutions to nine patients with Stokes-Adams attacks due to ventricular tachycardia and fibrillation and proved useful for prompt, short-term prevention of seizures.
New England Journal of MedicineTransvenous Left Atrial Pacing for the Control of Recurrent Ventricular Fibrillation
82 Citations1968Arthur J. Moss, Robert J. Rivers +3 more
A 67-year-old man with acute anterolateral myocardial infarction had recurrent ventricular fibrillation that required insertion of temporary pacemaker and left atrial pacing has continued.
The LancetURINARY EXCRETION OF FREE NORADRENALINE AND ADRENALINE FOLLOWING ACUTE MYOCARDIAL INFARCTION
78 Citations1967C Valori, Michaël Thomas +1 more
Serial measurements have been made of free noradrenaline and adrenaline in the urine of patients with acute myocardial infarction, and the level of excretion varied from normal values to approximately 800% of the mean normal level.
Circulation ResearchElectrophysiological Effects of Isoproterenol on Purkinje Fibers of the Heart
65 Citations1966D G Kassebaum, ALAN R. VAN DYKE
The electrophysiological effects of isoproterenol resemble those described previously for epinephrine, but the observations do not permit definition of the mechanism of action.
Circulation ResearchThe Effect of Epinephrine and Norepinephrine on Ventricular Vulnerability
61 Citations1955Brian F. Hoffman, Arthur A. Siebens +2 more
It is concluded that l-epinephrine and l-norepinephrine have qualitatively and quantitatively similar effects on ventricular vulnerability.
The American Journal of CardiologyFatal ventricular fibrillation during carotid sinus stimulation∗
59 Citations1966Sidney Alexander, Wong Chiu Ping
It is suggested that caution be used in applying carotid sinus stimulation to the critically ill patient who has received even modest amounts of cardiac glycosides.
American Journal of Physiology-Legacy ContentExcitability and electrical response of ischemic heart muscle
57 Citations1960Chandler McC. Brooks, Jerome L. Gilbert +3 more
It was found that action potentials shortened as did the refractory periods; thresholds fell momentarily and then rose progressively as tissue responsiveness failed due to continuing ischemia, and early re-establishment of a blood supply caused a reversal of the abnormalities.
Circulation ResearchPressure-Volume Correlates of Left Ventricular Oxygen Consumption in the Hypervolemic Dog
41 Citations1965Ellis L. Rolett, Peter M. Yurchak +2 more
The results of this study confirm the postulate that an increase in ventricular volume, as well as pressure, will be accompanied by an increaseIn ventricular oxygen consumption, which implies a relationship between the wall stress or force generated by the myocardium and the energy requirement of contraction.
The American Journal of CardiologyManagement of acute myocardial infarction complicated by advanced atrioventricular block
40 Citations1969J Beregovich, Sidney Fenig +2 more
Electrode catheters should be left in place, on a standby basis for an additional three to four weeks after re-establishment of sinus rhythm, in order to cover possible late recurrences of heart block.
Japanese Heart JournalMechanisms of Ventricular Fibrillation
20 Citations1966Yoshio Watanabe, Leonard S. Dreifus
During spontaneous ventricular fibrillation in isolated puppy hearts, the Purkinje-ventricular muscle junction was shown to be a possible site of conduction failure in the genesis of local block and irregular spread of excitation.
Circulation ResearchTransient Ventricular Conduction Disturbances Produced by Intra-atrial Injection of Single Doses of KCI
20 Citations1967Jaok Han, Anna Mae Malozzi +1 more
The results indicate that transient alterations of [K] in the blood of the ventricular cavity can act directly on the specialized conduction network to alter the rate of intraventricular conduction.
American Heart JournalVentricular vulnerability to paired-pulse stimulation during acute coronary occlusion
18 Citations1967Jaok Han, Anna Mae Malozzi +1 more
Pflügers Archiv - European Journal of PhysiologyBesitzen die sympathischen �bertr�gerstoffe einen direkten Einflu� auf die Leitungsgeschwindigkeit des S�ugetiermyokards?
17 Citations1967H. Antoni, Traude Zerweck
Acute Myocardial Infarction
5 Citations1991Noble O. Fowler