Protective Mechanism of containing sevoflurane HTK Solution on Cardiac Electrophysiology in Isolated Rat Cardiac Transplantation / 实用医学杂志

Objective To investigate the electrophysiological protective effect of HTK solution containing sevoflurane on rat cardiac transplantation. Methods Twenty-four male Sprague-Dawley rats were divided into the control group,sevoflurane group and Heptanol group. Rat hearts in 3 groups were stored in HTK solution,containing sevoflurane and sevoflurane+heptanol HTK solution for 6 h. Heart resuscitation time,the duration of arrhythmia and monophasic action potential(MAP)and heart rate(HR)at different time points were recorded.Monophasic action potential duration of repolarization at 50% and 90%(MAPD50 and MAPD90),monophasic action potential amplitude(MAPA)and maximal velocity(Vmax)were analyzed. Results The isolated rat hearts in each group can be successfully restored to the spontaneous heart beat. Compared with group C ,heart resuscitation time in group S and group H was significantly shortened,heart rate(HR)was significantly decreased at T1,MAPD50 and MAPD90 in heart intima and epicardium were shortened at T1 ~ T2,the incidence of ventricular fibrillation and reperfusion arrhythmia Scores were reduced,with the shorter duration of ventricular fibrillation(P<0.05). No significant difference was found in Vmax and MAPA among the three groups at each time point. Conclusion HTK solution containing sevoflurane and HTK solution containing heptanol had similar electrophysiological effects ,which could inhibit the prolonged monophasic action potential(MAP)and reduce arrhythmia. The electrophysiological protective effect of HTK solution containing sevoflurane may be associated with the inhibition of gap junction function.

Effects of Loading-dose of Rosuvastatin before PCI on Reperfusion Arrhythmias in Patients with Acute Non-ST-segment Elevation Myocardial Infarction / 中国药房

OBJECTIVE:To investigate the effects of loading-dose rosuvastain before early percutaneous coronary intervention (PCI) on reperfusion arrhythmias in patients with acute non-ST-segment elevation myocardial infarction (NSTEMI).METHODS:A total of 136 patients with NSTEMI were randomly divided into loading-dose group (68 cases) and control group (68 cases).Both groups who were not given anti-platelet drugs were given loading-dose of Aspirin enteric-coated tablets 300 mg+Clopidogrel sulfate tablets 600 mg immediately after admission.The patients who were given aspirin regularly were given loading-dose of Clopidogrel sulfate tablets 600 mg only once after admission.The patients who were given clopidogrel regularly were given loading-dose of Aspirin enteric-coated tablets 300 mg only once.Those received PCI 12-24 h after medication.After PCI,they took Aspirin enteric-coated tablets 100 mg for life+Clopidogrel bisulfate tablets 75 mg at least 12 months.Loading-dose group was given loading-dose of Rosuvastatin calcium tablets 20 mg orally,12 h before surgery.All patients began to take Rosuvastatin calcium tablets 10 mg,once a day,since the night after the operation.Coronary angiography and the occurrence of reperfusion arrhythmia were observed in 2 groups.The levels of CK-MB and cTnT,major adverse cardiovascular events (MACE) were observed before and after surgery.RESULTS:There was no statistical significance in the number of diseased vessels,culprit vessels,the degree of culprit vessels stenosis or the incidence of MACE between 2 groups (P＞ 0.05).The incidence of reperfusion arrhythmia in loading-dose group was significantly lower than control group,with statistical significance (P＜0.01).There was no statistical significance in the degree of culprit vessels stenosis between 2 groups (P＞0.05).Before surgery,there was no statistical significance in the levels of CK-MB or cTnT between 2 groups (P＞0.05).After surgery,the levels of CK-MB and cTnT in 2 groups were significantly higher than before surgery,but the loading-dose group was significantly lower than the control group,with statistical significance (P＜0.01).CONCLUSIONS:Preoperative loading-dose of rosuvastatin before PCI can reduce the incidence of reperfusion arrhythmias in NSTEMI patients.

Clinical analysis of reperfusion arrhythmia after direct PCI operation in acute ST segment elevation myocardial infarction / 重庆医学

Objective To explore the clinical characteristics of reperfusion arrhythmias (RA) in patients with ST segment el‐evation myocardial infarction(STEMI) after percutaneous coronary intervention (PCI) .Methods A total of 148 STEMI patients undergoing emergency PCI in our hospital from January 2010 to December 2014 were selected and divided into the RA group (71 cases) and non‐RA group (NRA group ,77 cases) according to whether RA occurring during PCI .The RA situation was observed . The relation between the infarct related artery and RA was analyzed ,the fall back situation of elevated ST segment was observed , the levels of cardiac troponin I (TnI) and creatine kinase isoenzyme MB (CK‐MB) and echocardiographic findings were compared between the two groups .Results The incidence rate of bradyarrhythmias in the left anterior descending coronary artery was signifi‐cantly lower than that in the right coronary artery and left circumflex artery ,while tachyarrhythmias in the left anterior descending coronary artery was higher than that in right coronary artery and left circumflex artery ,the differences were statistically significant (P<0 .05) .The opening time window and CK‐MB peak reaching time in the RA group were earlier than those in the NRA group , the fall amplitude of ST segment ,highest TnI and highest CK‐MB level in the RA group were higher tha those in the NRA group , the differences were statistically significant (P< 0 .05);among 48 cases of tachyarrhythmias ,tachyarrhythmia in 17 cases disap‐peared after intravenous drip or injection of lidocaine and which in 31 cases spontaneously disappeared without treatment ;among 23 cases of bradyarrhythmia ,bradyarrhythmia in 16 cases was controlled by intravenous injection of atropine ,which in 3 cases was con‐trolled within 1 week after placing temporary pacemaker and which in 4 cases was spontaneously disappeared without treatment . The incidence rate of main adverse events in the RA group was 2 .8% ,which was lower than 11 .7% in the NRA group ,the left ventricular ejection fraction in the RA group was significantly higher than that in the NRA group ,the end diastolic diameter and end systolic diameter of the left ventricle were significantly lower than those in the NRA group ,and the differences were statistically significant (P<0 .05) .Conclusion The incidence of RA in the patients with STEMI is higher ,which needs to adopt various effec‐tive methods to actively treat .

Inhibiting Effect of Amiodarone to Protective Action against Ischemia/Reperfusion Injury Induced by Ischemic Preconditioning / 대한마취과학회지

odarone. Isovolumetric left ventricular end systolic pressure (LVESP), left ventricular end diastolic pressure (LVEDP), dP/dtMAX and heart rate were measured. RESULTS: Group II showed more recovered LVESP, less developed ventricular stiffness, more preserved coronary effluent flow, earlier termination of arrhythmia and smaller infarct size than Group I. Group III showed preserved LVESP and dP/dtMAX, less developed ventricular stiffness, shortest arrhythmia sustaining time, smallest infarct size among all groups. These myocardial protective effects were abolished in Group IV. CONCLUSIONS: We observed that IPC and amiodarone administration, each has myocardial protective effects against myocardial ischemia, but when they are dealt at the same time, their beneficial effects diminished.

Anti-arrhythmic Effect of Melatonin in Reperfusion-induced Arrhythmia

BACKGROUND: Recently, a few studies demonstrated that melatonin reduced the severity of myocardial reperfusion injuries, such as reperfusion arrhythmias. However, it is uncertain whether the melatonin reduces reperfusion arrhythmias in thus anesthetized animals because results were obtained using isolated hearts. Thus, to see whether melatonin reduces reperfusion arrhythmias in anesthetized animals, we examined the effect of melatonin on the incidence of reperfusion arrhythmias in an anesthetized-cat model of regional ischemia. METHOD: Adult mongrel male cats(n=30, 2.9~4.2 kg) were anesthetized under positive-pressure artificial ventilation with room air. The animals of the control group(n=15) were subjected to 20-minute left anterior descending coronary artery(LAD) occlusion followed by abrupt reperfusion. The animals in experimental group(n=15) were divided into two. Group I(n=6) was pretreated with melatonin, 1 mg/kg, before occluding the LAD. Group II(n=9) was pretreated with melatonin, 10 mg/kg. The animals in experimental group were subjected to ischemia/reperfusion insult following drug treatment: melatonin was applied intra-peritoneally for 3 minutes just before LAD coronary artery ligation. The Fisher's exact test was used to compare the data from different animal groups. p<0.05 was considered significant. RESULTS: The incidence of ventricular fibrillation(VF) during the reperfusion phase in group II(pretreated with melatonin, 10 mg) was significantly smaller than that in the control group(p-value = 0.0029). However, no statistically significant difference of VF incidence was found between group I(pretreated with melatonin, 1 mg) and the control group. CONCLUSION: Employing an anesthetized-cat model of regional cardiac ischemia, we investigated the dose-dependant effects of melatonin on reperfusion-induced arrhythmia. The cats pretreated with 10 mg/kg of melatonin before ischemia had a significantly reduced incidence of lethal reperfusion-induced arrhythmia, but there was no difference between the cats pretreated with 1 mg/kg of melatonin before ischemia and the control group.

Clinical features and treatment for reperfusion arrhythmia / 中国综合临床

Objective To investigate clinical features of reperfusion arrhythmia (RA) following venous thrombolytic therapy by use of Urokinase (UK) for treating acute myocardial infarction (AMI),and to evaluate the effect of magnesium agent in treating RA.Methods 107 AMI cases admitted to our hospital were treated with UK who were divided into A (n=50) and B (n=57) groups.In B magnesium agent was injected into vein 20 minutes before thrombolytic therapy.Results According to clinical criteria,69 cases were recanalyzed with a recanalyzed rate of 64.49%.Before thrombolytic therapy,arrhythmia occurred in 36 cases.Of 31 recanalyzed cases in A group,25 cases presented with RA,whereas,of 38 recanalyzed cases in B group,13 cases presented with RA (P

A Prospective Study of Reperfusion Arrhythmias in Primary Coronary Angioplasty for Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: Arrhythmia is known to be a major cause of death in acute myocardial infarction (AMI). Reperfusion arrhythmias (RA) may also occur during angioplasty or thrombolysis. As yet, the clinical significances of RA and angiographic characteristics of the patients who develop RA during primary angioplasty and stenting are not clearly defined. METHODS: The study group consisted of 60 patients treated with primary angioplasty or stenting for AMI (angioplasty 13, stenting 47 patients). The patients were classified into 2 groups according to RA [RA (-) N=36/RA(+) N=24]: demographic and angiographic characteristics including time to reperfusion and incidence of pre-infarct angina were analyzed. RESULTS: The RA occurred in 40% of patients undergoing primary angioplasty or stenting (24/60 patients). The minor arrhythmias were more common after reperfusion (transient bradycardia 14, accelerated idioventricular rhythm 11, premature ventricular contraction 4 cases): major arrhythmias were uncommon (ventricular tachycardia/fibrillation 5, asystole 1 case). In the two groups, baseline clinical characteristics were similar except for pain to reperfusion time [RA (-): RA (+)=490.8+/-291.7: 252.9+/-109.2 minutes, P=0.001]. There was a trend toward a greater incidence of RA in the right coronary infarct-related artery [RA (-): RA (+)=16.7: 41.7%, P=NS]. The RA occurred in totally occluded artery (TIMI 0) with a giant thrombus and first ballooning in 19/24 patients (79.2%). The RA disappeared with conservative managements including pacemaker insertion and cardiopulmonary resuscitation and there were no differences in major adverse cardiac events in the two groups during follow-up. CONCLUSIONS: These findings suggest that the RA are frequent events during primary angioplasty but unrelated to clinical and angiographic characteristics except for reperfusion time and do not influence short-term prognosis in AMI.

The Effect of Hypoxic-Preconditioning on the Reperfusion-Induced Arrhythmias in the Cat Hearts

BACKGROUND: Ischemic preconditioning(a prior short period of coronary artery occlusion) has been known to have protective effects on ischemia-induced myocardial injury. The purpose of this study was to investigate the effects of hypoxic preconditioning or ischemic preconditioning on the

Direct PTCA of acute myocardial infarction-the relationship between type of balloon catheter and reperfu-sion arrhythmia / 中国介入心脏病学杂志

The relationship between type of balloon catheter and reperfusion arrhythmia (RA) of 97 patients with acute myocardial infarction (AMI) ,who had received direct PTCA has been studied. The incidence of RA in common balloon catheter treated group is 55. 4%,while that in perfusion balloon catheter treated group is 34. 4% and the extent of RA is less severe. During direct PTCA, perfusion balloon catheter can reduce the incidence and severity of RA.

A Study on Correlation between Occlusion and Reperfusion Arrhythmias in the Cats

Recently it has been stated that animals without ischemic arrhythmia would be at almost no risk for reperfusion ventricular fibrillation(VF) in contrast to animals with ischemic arrhythmias. In order to observe the differences of ararrhythmias characteristics between ischemic and reperfusion period, and correlationship between occlusion and reperfusion arrhythmias, the left anterior descending(LAD) coronary artery was occluded for 20 minutes and reperfused for 10 minutes in 24 anesthetized cats. The results were as follows; 1) After ligation of LAD coronary artery, the R wave, S-T segment and T wave of epicardial EKG were elevated to reach maximum level at 5-10 minutes. 2) During reperfusion, the changes of R wave, S-T segment, and T wave of epicardial EKG were not significant. 3) The incidence of arrhythmias at early phase and late phase of occlusion period were 41.6% and 100% respectively. The ischemic arrhythmia score was 2.38+/-1.61 and incidence of ventricular tachycardia(VT) was 66% 4) The incidence of VT and VF during reperfusion was 100% and 62.5% respectively. The reperfusion arrhythmia score was 5.88+/-1.72. 5) The two morphologies of ventricular arrhythmias were observed at occluson and reperfusion period. 6) The disparities between occlusion and reperfusion arrhythmias were observed. 7) The cats with shorter R-R internal and/or lower systolic left ventricualr pressure had the higher incidence of VF. In summary, although the morphology of occlusion ventricular arrhythmias was similar to that of reperfusion ventricular arrhythmias, the lack of correlation between reperfusion VF and ischemic arrhythmias was observed. So we suggest that further studies which provide the different mechanisms involved in occlusion and reperfusion arrhythmias were needed.

Influence of Autonomic Nervous System in Occlusion and Reperfusion Arrhythmia

In order to observe the development of arrhythmia during regional myocardial ischemia and reperfusion. Proximal left descending coronary artery(LAD) was ligated for 20 minutes and reperfused suddenly in fifty one cats which were grouped into control(n=16), alpha-receptor block group(n=8), beta-receptor block group (n=9), parasymphathetic system block group (n=10) and autonomic nervous system block group(n=8). In drug infused groups, drug infusion was started 5 minutes prior to occlusion with bolus. Epicardial electrocardiogram, left ventricular pressure and standard ECG(lead I) were simultaneously recorded with the paper speed of 25mm/sec at predetermined time intervals and when arrhythmias occurred, and those were recorded continuousely with the paper speed of 5mm/sec throughout the experiment. The results were as follows : 1) After ligation of LAD, the R wave and ST segment of QRS of epicardial ECG elevated to reach maximum level with first 10 minutes. 2) The incidence of occlusion ventricular tachycardia in autonomic nervous system block group and alpha-receptor block group was significantly lower than control group(P<0.01). 3) The incidence of reperfusion ventricular tachycardial and ventricular fibrillation in autonomic nervous system block group, beta-receptor block group and alpha-receptor block group was significantly lower than control group(P<0.05). 4) The arrhythmia score during LAD occlusion in autonomic nervous system block group and alpha-receptor block group was significantly lower than control group(P<0.05). 5) The arrhythmia score in reperfusion in autonomic nervous system block group, beta-receptor block group and alpha-receptor block group was significantly lower than control group (P<0.05). It was concluded that the reperfusion arrhythmia could be prevented by alpha-receptor and beta-receptor block. There was the synergism between alpha-receptor blocker and beta-receptor blokcer. But the occlusion arrhythmia was suppressed by only alpha-receptor blocker.