牛磺酸镁抗豚鼠尖端扭转型室速的作用研究

目的：研究牛磺酸镁配位化合物（TMCC）抗豚鼠心脏尖端扭转型室速（TdP）的作用。方法：取健康、体重250~300 g的成年雄性豚鼠,随机分为4组：① TdP模型组（n=7）：离体心脏以K-H灌流液灌流20 min,然后使用IKs阻滞剂10μmol/L Chromanol 293B合并低钾（钾离子浓度为1.8 mmol/L）进行灌流,建立TdP模型。②~④ TdP模型+TMCC低中高浓度组（n=6）：正常灌流稳定20 min后,在建立TdP模型的同时分别给予1、2、4 mmol/L TMCC。采用Langendorff逆行主动脉灌流法灌流豚鼠离体心脏,利用Biopac电生理记录仪采集并记录豚鼠离体心脏表面心电图。从心电图第Ⅱ导联图形获取各组豚鼠离体心脏TdP发生率、跨室壁复极离散度、QT间期不稳定性,以观察TMCC对TdP的影响。观测指标量取时间分别为：豚鼠离体心脏正常灌流20 min时、TdP发生前及给药60 min时。结果：TdP模型组的TdP发生率为6/7。1、2、4mmol/L TMCC可降低TdP发生率,三组TdP发生率分别为5/6、1/6、0/6。与给药前相比,TdP模型组中Chromanol 293 B合并低钾可使豚鼠离体心脏校正后的跨室壁复极离散度显著增大（P<0.01）;与TdP模型组相比,TdP模型+1、2、4mmol/L TMCC组可明显减弱Chromanol 293B合并低钾导致的豚鼠离体心脏校正后的跨室壁复极离散度增大（P>0.05）。与模型组相比,2、4mmol/L TMCC明显降低Chromanol 293B合并低钾导致的QT间期不稳定增大（P<0.05）。在TdP模型建立过程中,从心电图中可观察到连续多个心动周期的P波消失,而在TdP模型+TMCC组中,心电图始终拥有独立P波。结论：TMCC可通过降低离体心脏跨室壁复极离散度和QT间期不稳定性以及抑制早后除极的发生而发挥抗TdP作用,降低TdP发生率。     

严重烫伤延长大鼠心室肌细胞动作电位时程的机制

严重烫伤引起心肌细胞动作电位时程（action potential duration,APD）延长,通过加重烫伤心肌细胞钙紊乱和诱发室性心律失常,促进烫伤心功能障碍的发生,但APD延长的机制尚不清楚。通过制作约40％体表面积（total body surface area,TBSA）Ⅲ度烫伤大鼠模型,在伤后12h大鼠心功能明显减弱时分离其心肌细胞,采用膜片钳技术观察心肌细胞APD以及动作电位复极化相关的重要离子通道电流,包括瞬间外向钾电流（transient outward K^＋ current,Ito）,L-型钙电流（L-type Ca^2＋ current,ICa-L）和内向整流钾电流（inward rectifier K^＋ current,IK1）。结果显示,烫伤后12h单个心肌细胞APD明显延长,APD50和APD90在烫伤组分别为（46．02±3．78）ms、（123．24±12．48）ms（n=19）,明显长于对照组的（23．28±4．85）ms、（72．12±3．57）ms（n=17）（P〈0．01）。烫伤引起,Ito电流密度降低,＋60 mV下烫伤组的电流密度（20．39±1．98）pA／pF（n=25）明显低于对照组的（34．15±3．78）pA／pF（n=20,P〈0．01）;烫伤组在-120至-80mV电压刺激下所产生的IK1电流密度显著低于对照组：而两组之间ICa-L电流密度、电压依赖性的激活和失活无显著性差异。结果提示,烫伤引起心肌细胞APD延长的机制与瞬间外向钾通道和内向整流钾通道功能下调有关。     

小鼠主动脉狭窄后不同时期心室肌细胞后除极和触发活动的变化

目的：探讨小鼠主动脉狭窄后不同时期心室肌细胞后除极和触发活动的变化及可能的机制。方法：复制小鼠主动脉狭窄模型后,取小鼠心脏,采用玻璃微电极技术,记录左心室乳头肌动作电位早后除极（EAD）、迟后除极（DAD）和触发活动情况,以及灌流低钾或异丙肾上腺素溶液后,所诱发后除极触发活动的变化。结果：①与同时期对照组比较,小鼠乳头肌动作电位APD90模型组2周和5周组保持不变,9周和13周明显延长。②在记录的30min时间内,模型组9周和13周动物出现EAD和DAD,而对照组以及模型组2周和5周动物未出现EAD和DAD。③低钾或异丙肾上腺素诱发EAD和DAD的发生率,模型组显著高于同期对照组,并且模型组动物的发生率随着时间进行性增加。结论：小鼠主动脉狭窄后,心肌细胞EAD、DAD以及触发活动逐渐增多,心肌细胞的电不稳定性逐渐增加。     

二十二碳六烯酸对心房颤动大鼠心房肌生理改变及双孔钾通道TASK-1蛋白表达的影响

目的：探讨二十二碳六烯酸（DHA）对大鼠心房颤动（AF）模型心房肌生理特性的影响及相关机制研究。方法：80只乙酰胆碱-氯化钙混合液敏感的SD大鼠分为对照组（CTL组）、DHA处理组（DHA组）、房颤组（AF组）和房颤+DHA处理组（DHA+AF组）,观察房颤持续时间;采用全细胞膜片钳技术记录大鼠心房肌细胞动作电位时程（APD）和双孔钾通道TASK-1电流,Western blot测定大鼠心房组织TASK-1蛋白表达。结果：大鼠尾静脉注射乙酰胆碱-氯化钙混合液后,房颤持续时间随实验天数增加而逐渐延长,DHA干预缩短房颤持续时间。与CTL组相比,AF组大鼠心房肌细胞复极50%时的动作电位时程（APD₅₀）和复极90%时的动作电位时程（APD₉₀）明显缩短,心房肌细胞TASK-1电流密度升高,蛋白表达升高（P<0.05）。与AF组相比,DHA+AF组大鼠心房肌细胞APD₅₀和APD₉₀明显延长,TASK-1电流密度和蛋白表达降低（P<0.05）。结论：DHA具有延长房颤大鼠心房肌细胞APD的作用,可能与其下调心房肌TASK-1蛋白的表达从而降低心房肌细胞TASK-1电流密度有关。     

压力负荷性心衰小鼠左心室跨壁L-型钙电流的变化

为了观察正常和心衰时心内膜下和心外膜下心肌细胞L-型钙电流(ICa-L)的差别,我们采用主动脉弓狭窄的方法建立小鼠压力超负荷性心衰模型,采用全细胞膜片钳技术记录了正常、主动脉狭窄(band)及假手术对照(sham)组动物左心室游离壁内、外膜下心肌细胞的动作电位时程(action potential duration,APD)和ICa-L。结果显示:(1)与sham组同龄的正常小鼠左心室心内膜下细胞动作电位复极达90％的时程(APD90)为(38．2±6．44)ms,较心外膜下细胞的APD90(15.67±5.31)ms明显延长,二者的比值约为2．5:1;内膜下细胞和外膜下细胞ICa-L密度没有差异,峰电流密度分别为(-2.7±0.49)pA/pF和(-2.54±0．53)pA/pF;(2)Band组内、外膜下细胞的动作电位复极达50％的时程(APD50)、APD90均较sham组显著延长,尤以内膜下细胞延长突出,分别较sham组延长了400％和360％,内、外膜下细胞APD90的比值约为4.2:1;(3)与sham组相比, band组内膜下细胞ICa-L密度显著减小,在+10 mV～+40 mV的4个电压下分别降低了20．2％、21．4％、21.6％和25.7％(P< 0．01),但其激活电位、峰电位和翻转电位没有改变;band组外膜下细胞的ICa-L密度与同期sham组相比无明显变化;band组钙通道激活、失活及复活的动力学特征与sham组相比没有改变。以上结果提示,生理状态下小鼠左心室内、外膜下细胞ICa-L密度不存在明显差别,提示ICa-L与APD跨壁异质性的产生无关;心衰时左心室内、外膜下细胞APD明显延长,以内膜下细胞延长尤为突出,内膜下细胞ICa-L密度明显减少,而外膜下细胞ICa-L密度无明显改变,这种ICa-L的非同步变化在心衰时可能起到对抗APD延长、减少复极离散度的有益作用。     

镁对缺血性心肌电变化的保护作用

本工作研究了镁对模拟缺血条件（用低氧分压、无糖、高钾及高乳酸台氏液浸浴心肌）下的离体豚鼠心室肌细胞跨膜电位（TMP）和机能不应期（FRP）变化,以及在体兔心急性心肌缺血时FRP变化的影响。高镁（[M^2 ].8mmol/L）使模拟缺血豚鼠心室肌细胞静息电位（RP）、动作电位振幅（APA）及动作电位0期最大上升速度（Vmax)相对增大,动作电位时程（APD）相对延长,镁对缺血心肌FRP的变化具有双重作用,既可使过分延长的不应期相对缩短,减轻复极后不应性（PRP）;又可使缩短的不应期相对延长,从而减轻了不应期离散程度,镁的上述作用对改善缺血心肌的兴奋性,传导性,减少折返激动的发生具有重要意义。     

全心缺血早期阶段室性心律失常仿真研究

为了分析全心缺血早期阶段对心脏电生理活动的影响,以及探讨诱发的室性心律失常机制,本研究考虑了缺血情况下高钾、酸液过多、局部缺氧的情况,结合详细的人类心室细胞生物物理上的动力学特征,开发了一个人体心室细胞和组织全心缺血模型.实验结果表明,全心缺血缩短了动作电位时程(action potential duration,APD),且减缓了兴奋的传导速率(conduction velocity,CV).同时,由于全心缺血降低了动作电位时程曲线(action potential duration restitution,APDR)斜率,且增大了有效不应期(effective refractory period,ERP),因此有利于维持折返波的稳定传导,使得室速不易转化为室颤.另一方面,尽管全心缺血导致了组织易感性的增加,但是由于其需要更长的异位刺激长度来保证折返波的形成,因此也在一定程度上降低了心律失常的发生概率.     

高钙对兔窦房结的负性变时作用

本文采用常规微电极技术在离体兔心窦房结标本上研究了细胞外钙离子浓度([Ca~(2 )]_0)对窦房结的变时性作用。结果显示,[Ca~(2 )]_0的递增(1.1—5.5mM),对窦性周期(CL)大于400ms 的标本引起双相变时作用,但对CL小于400ms的标本却引起负性变时作用。阿托品(0.5mg/l)和心得安(0.2mg/l)对[Ca~(2 )]_0 的变时作用无明显影响。随着[Ca~(2 )]_0的递增,窦房结优势起搏细胞的动作电位幅度、最大舒张期电位和0期最大除极速度均降低,舒张期自动除极化斜率增加,起始电位上移,动作电位时程(APD)延长。高[Ca~(2 )]_0时窦房结起搏细胞的有效不应期(ERP)延长、ERP/APD增大,ERP点的阈值提高(P<0.01)。 上述结果表明,高[Ca~(2 )]_0引起窦房结的负性变时效应,这种作用不是通过交感和副交感神经的传递,而可能是 Ca~(2 )直接作用于窦房结起搏细胞引起其电活动改变的结果。     

肾上腺素能受体阻断剂预防慢性压力超负荷左心室的电重构

研究长期使用肾上腺素能受体阻断剂治疗对慢性压力超负荷左心室电重构的影响。新西兰兔通过肾上腹主动脉次全结扎诱发慢性压力超负荷,10周后行心脏超声检查,并采用全细胞膜片钳技术分别记录腹主动脉结扎组(简称结扎组)、腹主动脉结扎 Carvedilol 干预组(简称Carvedilol组)及正常对照组(简称对照组)动物左室肌中层细胞的动作电位(action potential,AP)、内向整流钾电流(inward rectifier potassium current,IKi)、延迟整流钾电流(delayed rectifier potassium current,IK)及Na /Ca2 交换体电流。结果表明,结扎组的左室质量指数较对照组明显升高,Carvedilol组较结扎组明显降低(P<0.01)。在2 s的基础周长下,动作电位持续时间(以90％的复极时间表示,简称APD90)在对照组、结扎组及Carvedilol组分别为522.0±19.5 ms(n=6)、664.7± 46.2 ms(n=7)、567.8±14.3 ms(n=8),结扎组同对照组相比,P<0.01,Carvedilol组同结扎组相比,P<0.05。在测试电位为-100mV时,IKi电流密度(pA/pF)在对照组、结扎组及Carvedilol组分别为-11.8±0.50(n=8),-8.07±0.28 (n=8),-10.69±0.35(n=8),结扎组与对照组及Carvedilol组相比,P<0.01。在测试电位为 50 mV时,IK尾电流密度(pA/pF)在对照组、结扎组及Carvedilol组分别为0.59±0.40(n=     

苯肾上腺素对豚鼠和兔离体心室乳头肌的作用

在心得安(1μM)阻断β-受体的情况下,本文通过观察苯肾上腺素(PE)对豚鼠和兔心室乳头肌动作电位及收缩的作用,探讨了心脏α-受体兴奋引起正性变力作用的机制。PE(1—16μM)延长豚鼠心室乳头肌动作电位时程(APD),增加兔和豚鼠心室乳头肌的收缩幅度(AC)。PE 在兔心室乳头肌上表现出的正性变力作用比在豚鼠心室肌上显著得多。FE(16μM)加强兔和豚鼠心室乳头肌收缩力的作用可被α_1-受体阻断剂哌唑嗪(Prazosin)(0.3—0.5μM)所取消。然而,在豚鼠心室乳头肌上被PE延长的APD,仅APD_(30)在哌唑嗪作用下有所缩短,而APD_(90)则不受其影响。在高钾(22mM)除极的心室乳头肌,PE(50μM)使 9个兔标本中的8个、8个豚鼠标本中的2个分别恢复慢反应动作电位。这些慢反应动作电位可被哌唑嗪(1μM)或钙通道阻断剂Mn~( )(1mM)所取消或抑制。以上的结果提示心脏α-肾上腺素能受体兴奋引起正性变力作用可能是由于慢内向电流(I_si)的增加。     

Role of Sarcoplasmic Reticulum Calcium in Development of Secondary Calcium Rise and Early Afterdepolarizations in Long QT Syndrome Rabbit Model

Background

L-type calcium current reactivation plays an important role in development of early afterdepolarizations (EADs) and torsades de pointes (TdP). Secondary intracellular calcium (Ca_i) rise is associated with initiation of EADs.

Objective

To test whether inhibition of sarcoplasmic reticulum (SR) Ca²⁺ cycling suppresses secondary Ca_i rise and genesis of EADs.

Methods

Langendorff perfusion and dual voltage and Ca_i optical mapping were conducted in 10 rabbit hearts. Atrioventricular block (AVB) was created by radiofrequency ablation. After baseline studies, E4031, SR Ca²⁺ cycling inhibitors (ryanodine plus thapsigargin) and nifedipine were then administrated subsequently, and the protocols were repeated.

Results

At baseline, there was no spontaneous or pacing-induced TdP. After E4031 administration, action potential duration (APD) was significantly prolonged and the amplitude of secondary Ca_i rise was enhanced, and 7 (70%) rabbits developed spontaneous or pacing-induced TdP. In the presence of ryanodine plus thapsigargin, TdP inducibility was significantly reduced (2 hearts, 20%, p = 0.03). Although APD was significantly prolonged (from 298 ± 30 ms to 457 ± 75 ms at pacing cycle length of 1000 m, p = 0.007) by ryanodine plus thapsigargin, the secondary Ca_i rise was suppressed (from 8.8 ± 2.6% to 1.2 ± 0.9%, p = 0.02). Nifedipine inhibited TdP inducibility in all rabbit hearts.

Conclusion

In this AVB and long QT rabbit model, inhibition of SR Ca²⁺ cycyling reduces the inducibility of TdP. The mechanism might be suppression of secondary Ca_i rise and genesis of EADs.     

Pronounced Effects of HERG-Blockers E-4031 and Erythromycin on APD,Spatial APD Dispersion and Triangulation in Transgenic Long-QT Type 1 Rabbits

Background

Prolongation of action potential duration (APD), increased spatial APD dispersion, and triangulation are major factors promoting drug-induced ventricular arrhythmia. Preclinical identification of HERG/I_Kr-blocking drugs and their pro-arrhythmic potential, however, remains a challenge. We hypothesize that transgenic long-QT type 1 (LQT1) rabbits lacking repolarizing I_Ks current may help to sensitively detect HERG/I_Kr-blocking properties of drugs.

Methods

Hearts of adult female transgenic LQT1 and wild type littermate control (LMC) rabbits were Langendorff-perfused with increasing concentrations of HERG/I_Kr-blockers E-4031 (0.001–0.1 µM, n = 9/7) or erythromycin (1–300 µM, n = 9/7) and APD, APD dispersion, and triangulation were analyzed.

Results

At baseline, APD was longer in LQT1 than in LMC rabbits in LV apex and RV mid. Erythromycin and E-4031 prolonged APD in LQT1 and LMC rabbits in all positions. However, erythromycin-induced percentaged APD prolongation related to baseline (%APD) was more pronounced in LQT1 at LV base-lateral and RV mid positions (100 µM, LQT1, +40.6±9.7% vs. LMC, +24.1±10.0%, p<0.05) and E-4031-induced %APD prolongation was more pronounced in LQT1 at LV base-lateral (0.01 µM, LQT1, +29.6±10.6% vs. LMC, +19.1±3.8%, p<0.05) and LV base-septal positions. Moreover, erythromycin significantly increased spatial APD dispersion only in LQT1 and increased triangulation only in LQT1 in LV base-septal and RV mid positions. Similarly, E-4031 increased triangulation only in LQT1 in LV apex and base-septal positions.

Conclusions

E-4031 and erythromycin prolonged APD and increased triangulation more pronouncedly in LQT1 than in LMC rabbits. Moreover, erythromycin increased APD dispersion only in LQT1, indicating that transgenic LQT1 rabbits could serve as sensitive model to detect HERG/I_Kr-blocking properties of drugs.     

Electrocardiographic Screening for Prolonged QT Interval to Reduce Sudden Cardiac Death in Psychiatric Patients: A Cost-Effectiveness Analysis

ImportanceSudden cardiac death is a leading cause of mortality in psychiatric patients. Long QT (LQT) is common in this population and predisposes to Torsades-de-Pointes (TdP) and subsequent mortality.ObjectiveTo estimate the cost-effectiveness of electrocardiographic screening to detect LQT in psychiatric inpatients.ResultsIn the base-case scenario, the numbers of patients needed to screen were 1128 and 2817 to avoid one TdP and one death, respectively. The ICER of systematic ECG screening was $8644 (95%CI, 3144-82 498) per QALY. The probability of cost-effectiveness was 96% at a willingness-to-pay of $50 000 for one QALY. In sensitivity analyses, results were sensitive to the case-fatality of TdP episodes and to the TdP reduction following the diagnosis of LQT.

Conclusion and Relevance

In psychiatric hospitals, performing systematic ECG screening at admission help reduce the number of sudden cardiac deaths in a cost-effective fashion.     

Ventricular hypertrophy amplifies transmural repolarization dispersion and induces early afterdepolarization

The effects of left ventricular hypertrophy (LVH) on the generation of phase 2 early afterdepolarization (EAD) and transmural dispersion of repolarization (TDR) were assessed using arterially perfused rabbit ventricular wedge preparations. Transmembrane action potentials from epicardium, subendocardium, and endocardium were simultaneously recorded together with a transmural ECG. Transmural action potential duration (APD) was also mapped. LVH (renovascular hypertension model) produced significant prolongation in ventricular APD and QT interval. Preferential APD prolongation in subendocardium and endocardium was associated with a marked increase in TDR. Phase 2 EADs were generated from subendocardium or endocardium in all LVH rabbits (15 of 15) in the absence of APD prolonging agents at basic cycle lengths of 2,000-4,000 ms. Phase 2 EAD could produce "R on T" extrasystoles, initiating polymorphic ventricular tachycardia (VT). This study provides the first direct evidence from intracellular recordings that phase 2 EAD could be generated from rabbit intact hypertrophied LV wall in the absence of APD prolonging agents, resulting in R on T extrasystoles capable of initiating polymorphic VT under enhanced TDR.     

心室不同部位起搏对正常犬和扩张型心肌病心力衰竭犬模型在体心肌跨室壁复极离散的影响

实验以正常犬和扩张型心肌病心力衰竭犬(dilated cardiomyopathy congestive heart failure,DCM-CHF)模型为对象、以心肌跨室壁复极离散的相关参数为指标,研究左心室心外膜起搏、双心室起搏(模拟临床上心室再同步治疗的方法)后的心肌电生理特性变化。实验以快速右心室起搏的方法制备DCM-CHF犬模型;正常犬和DCM-CHF犬均经射频消融希氏束制备三度房室传导阻滞模型;采用同步记录犬体表心电图和内膜下、中层、外膜下三层心肌单相动作电位(monophasic action potentials,MAP)的方法,测定不同部位起搏时的QT间期、Tpeak-Tend(Tp-Te)间期和三层心肌的单相动作电位时程(MAP duration,MAPD)、跨室壁复极离散度(transmural dispersion of repolaization,TDR)。结果显示:在正常犬,左室心外膜与双心室起搏后三层心肌的MAPD均延长,同时TDR增大(左室心外膜起搏47.16 ms、双心室起搏37.54 ms、右室心内膜起搏26.75 ms,P<0.001),体表心电图Tp-Te间期的变化与之平行;在DCM-CHF犬较正常犬已表现出中层心肌MAPD延长(276.30 ms vs 257.35 ms,P<0.0001)和TDR(33.8 ms vs 27.58 ms,P=0.002)增大的基础上,左室心外膜参与起搏后仍进一步使三层心肌的MAPD延长和TDR增大。研究结果提示,左室心外膜起搏和双心室起搏后使内膜下、中层     

Pharmacogenomics of anesthetic drugs in transgenic LQT1 and LQT2 rabbits reveal genotype-specific differential effects on cardiac repolarization

Anesthetic agents prolong cardiac repolarization by blocking ion currents. However, the clinical relevance of this blockade in subjects with reduced repolarization reserve is unknown. We have generated transgenic long QT syndromes type 1 (LQT1) and type 2 (LQT2) rabbits that lack slow delayed rectifier K+ currents (IKs) or rapidly activating K+ currents (IKr) and used them as a model system to detect the channel-blocking properties of anesthetic agents. Therefore, LQT1, LQT2, and littermate control (LMC) rabbits were administered isoflurane, thiopental, midazolam, propofol, or ketamine, and surface ECGs were analyzed. Genotype-specific heart rate correction formulas were used to determine the expected QT interval at a given heart rate. The QT index (QTi) was calculated as percentage of the observed QT/expected QT. Isoflurane, a drug that blocks IKs) prolonged the QTi only in LQT2 and LMC but not in LQT1 rabbits. Midazolam, which blocks inward rectifier K+ current (IK1), prolonged the QTi in both LQT1 and LQT2 but not in LMC. Thiopental, which blocks both IKs and IK1, increased the QTi in LQT2 and LMC more than in LQT1. By contrast, ketamine, which does not block IKr, IKs, or IK1, did not alter the QTi in any group. Finally, anesthesia with isoflurane or propofol resulted in lethal polymorphic ventricular tachycardia (pVT) in three out of nine LQT2 rabbits. Transgenic LQT1 and LQT2 rabbits could serve as an in vivo model in which to examine the pharmacogenomics of drug-induced QT prolongation of anesthetic agents and their proarrhythmic potential. Transgenic LQT2 rabbits developed pVT under isoflurane and propofol, underlining the proarrhythmic risk of IKs blockers in subjects with reduced IKr.     

Non-invasive Determination of the Optimized Atrioventricular Delay in Patients with Implanted Biventricular Pacing Devices

Background

Biventricular (BiV) is extensively used in the treatment of congestive heart failure but so far no recommendations for optimized programming of atrioventricular-delay (AVD) settings have been proposed. Can AVD optimization be performed using a simple formula based on non-invasive doppler-echocardiography?

Methods

25 patients (ejection fraction 30±8%) received BiV ICDs. Doppler-echocardiographic evaluation of diastolic and systolic flow was performed for different AVDs (30ms to 150ms) and different stimulation sites (left ventricular (LV), right ventricular and BiV). The optimal atrioventricular delay was calculated applying a simple formula based on systolic and diastolic mechanical delays determined during doppler-echocardiography.

Results

The mean optimal AVD was calculated to be 112±29ms (50 to 180ms) for BiV, 95±30ms (65 to 150ms) for LV and 75±28ms (40 to 125ms) for right ventricular pacing with wide interindividual variations. Compared to suboptimal AVDs diastolic optimization improved preejection and ejection intervals independent to pacing site. Optimization of the AVD significantly increased ejection time during BiV pacing (279ms versus 266ms; p<0.05). Compared to LV or right ventricular pacing BiV pacing produced the shortest mean pre-ejection and longest ejection intervals as parameters of improved systolic ventricular contractile synchrony. Diastolic filling times were longest during BiV pacing compared to LV or RV pacing.

Conclusions

Individual programming of BiV pacing devices increases hemodynamic benefit when implementing the inter-individually widely varying electromechanical delays. Optimization applying a simple formula not only improves diastolic ventricular filling but also increases systolic functional parameters.     

Stochastic Cardiac Pacing Increases Ventricular Electrical Stability—A Computational Study

The ventricular tissue is activated in a stochastic rather than in a deterministic rhythm due to the inherent heart rate variability (HRV). Low HRV is a known predictor for arrhythmia events and traditionally is attributed to autonomic nervous system tone damage. Yet, there is no model that directly assesses the antiarrhythmic effect of pacing stochasticity per se. One-dimensional (1D) and two-dimensional (2D) human ventricular tissues were modeled, and both deterministic and stochastic pacing protocols were applied. Action potential duration restitution (APDR) and conduction velocity restitution (CVR) curves were generated and analyzed, and the propensity and characteristics of action potential duration (APD) alternans were investigated. In the 1D model, pacing stochasticity was found to sustain a moderating effect on the APDR curve by reducing its slope, rendering the tissue less arrhythmogenic. Moreover, stochasticity was found to be a significant antagonist to the development of concordant APD alternans. These effects were generally amplified with increased variability in the pacing cycle intervals. In addition, in the 2D tissue configuration, stochastic pacing exerted a protective antiarrhythmic effect by reducing the spatial APD heterogeneity and converting discordant APD alternans to concordant ones. These results suggest that high cardiac pacing stochasticity is likely to reduce the risk of cardiac arrhythmias in patients.     

Recent advances in understanding sex differences in cardiac repolarization

A number of gender differences exist in the human electrocardiogram (ECG): the P-wave and P-R intervals are slightly longer in men than in women, whilst women have higher resting heart rates than do men, but a longer rate-corrected QT (QT_C) interval. Women with the LQT1 and LQT2 variants of congenital long-QT syndrome (LQTS) are at greater risk of adverse cardiac events. Similarly, many drugs associated with acquired LQTS have a greater risk of inducing torsades de pointes (TdP) arrhythmia in women than in men. There are also male:female differences in Brugada syndrome, early repolarisation syndrome and sudden cardiac death. The differences in the ECG between men and women, and in particular those relating to the QT interval, have been explored experimentally and provide evidence of differences in the processes underlying ventricular repolarization. The data available from rabbit, canine, rat, mouse and guinea pig models are reviewed and highlight involvement of male:female differences in Ca and K currents, although the possible involvement of rapid and persistent Na current and Na–Ca exchange currents cannot yet be excluded. The mechanisms underlying observed differences remain to be elucidated fully, but are likely to involve the influence of gonadal steroids. With respect to the QT interval and risk of TdP, a range of evidence implicates a protective role of testosterone in male hearts, possibly by both genomic and non-genomic pathways. Evidence regarding oestrogen and progesterone is less unequivocal, although the interplay between these two hormones may influence both repolarization and pro-arrhythmic risk.