LPC对缺血心肌起搏离子流的影响及ISO的效应

目的:观察在缺血条件下,溶血磷脂酰胆碱(LPC)对心肌起搏离子流(If)的影响以及能否被异丙肾上腺素(ISO)逆转.方法:采用双微电极电压钳制术,在各钳制电位测定并比较缺血心肌加入LPC和LPC加ISO的起搏离子流(If)幅值.结果:缺血降低If幅值,在模拟缺血液中加入LPC 2×10-5mol/L,If幅值在Ec -80～-120 mV水平进一步显著降低(n=5,P<0.05),加重了缺血对If离子流的抑制作用.在模拟缺血液中同时加入LPC 2×10-5mol/L和ISO 1×10-6mol/L,If幅值在Ec -90～-120 mV水平比模拟缺血时有显著增加(n=8,P<0.05),但未能达到缺血前基础水平.结论: 急性心肌缺血时,毒性代谢产物 LPC 加重起搏离子流的受抑程度,即使局部儿茶酚胺大量释放和积聚,也不能完全逆转上述抑制效应.     

Entrainment, Instability, Quasi-periodicity, and Chaos in a Compound Neural Oscillator

We studied the dynamical behavior of a class of compound central pattern generator (CPG) models consisting of a simple neural network oscillator driven by both constant and periodic inputs of varying amplitudes, frequencies, and phases. We focused on a specific oscillator composed of two mutually inhibiting types of neuron (inspiratory and expiratory neurons) that may be considered as a minimal model of the mammalian respiratory rhythm generator. The simulation results demonstrated how a simple CPG model— with a minimum number of neurons and mild nonlinearities— may reproduce a host of complex dynamical behaviors under various periodic inputs. In particular, the network oscillated spontaneously only when both neurons received adequate and proportionate constant excitations. In the presence of a periodic source, the spontaneous rhythm was overriden by an entrained oscillation of varying forms depending on the nature of the source. Stable entrained oscillations were inducible by two types of inputs: (1) anti-phase periodic inputs with alternating agonist-antagonist drives to both neurons and (2) a single periodic drive to only one of the neurons. In-phase inputs, which exert periodic drives of similar magnitude and phase relationships to both neurons, resulted in varying disruptions of the entrained oscillations including magnitude attenuation, harmonic and phase distortions, and quasi-periodic interference. In the absence of significant phasic feedback, chaotic motion developed only when the CPG was driven by multiple periodic inputs. Apneic episodes with repetitive alternation of active (intrinsic oscillation) and inactive (cessation of oscillation) states developed when the network was driven by a moderate periodic input of low frequency. %and amplitudes of intermediate strength, Similar results were demonstrated in other, more complex oscillator models (that is, half-center oscillator and three-phase respiratory network model). These theoretical results may have important implications in elucidating the mechanisms of rhythmogenesis in the mature and developing respiratory CPG as well as other compound CPGs in mammalian and invertebrate nervous systems.     

Magnetic resonance imaging,pacemakers and implantable cardioverter-defibrillators: current situation and clinical perspective

New developments and expanding indications have resulted in a significant increase in the number of patients with pacemakers and internal cardioverterdefibrillators (ICDs). Because of its unique capabilities, magnetic resonance imaging (MRI) has become one of the most important imaging modalities for evaluation of the central nervous system, tumours, musculoskeletal disorders and some cardiovascular diseases. As a consequence of these developments, an increasing number of patients with implanted devices meet the standard indications for MRI examination. Due to the presence of potential life-threatening risks and interactions, however, pacemakers and ICDs are currently not approved by the Food and Drug Administration (FDA) for use in an MRI scanner. Despite these limitations and restrictions, a limited but still growing number of studies reporting on the effects and safety issues of MRI and implanted devices have been published. Because physicians will be increasingly confronted with the issue of MRI in patients with implanted devices, this overview is given. The effects of MRI on an implanted pacemaker and/or ICDs and vice versa are described and, based on the current literature, a strategy for safe performance of MRI in these patients is proposed. (Neth Heart J 2010;18:31-7.)     

Non-ischemic cardiomyopathy patients derive superior mortality benefit from cardiac resynchronization therapy

Background

Cardiac Resynchronization Therapy (CRT) is indicated for the treatment of advanced heart failure with severe systolic dysfunction and intraventricular conduction delay. Patient selection for this technology is vital, though it remains unclear which patients benefit most from CRT. We tested the hypothesis that patients with non-ischemic cardiomyopathy have a superior mortality benefit from CRT than ischemic cardiomyopathy patients.

Methods

We evaluated 95 CRT patients to determine which factors predict mortality.

Results

Patients with non-ischemic cardiomyopathy had a significantly better prognosis than patients with ischemic cardiomyopathy.

Conclusion

Larger prospective studies can substantiate this finding and better delineate which patients benefit most from CRT.     

A mysterious pacemaker suture: an uncommon foreign body reaction

Surgical suture material is usually inert and nontoxic and causes minimal inflammation of tissue. However, foreign body reactions to various suture types can lead to granuloma, abscess, or even sinus formation. We report an elderly female who was incidentally detected to have a mass protruding from the incision site which was confirmed histopathologically a chronic granulomatous reaction to non absorbable suture. The foreign body granulomatous reaction to suture material in the setting of pacemaker implantation has not been described in the literature. We also discuss the existing literature on this underrecognised entity.     

Diagnostic tools for atrial tachyarrhythmias in implantable pacemakers: a review of technical options and pitfalls

Background. Correct pacemaker (PM) diagnosis of paroxysmal atrial tachyarrhythmias is crucial for their prevention and intervention with specific atrial pacing programmes. The PM mode switch to only ventricular pacing after detection of atrial tachyarrhythmias is often used as the parameter to quantify the ‘burden’ of atrial tachyarrhythmias. Objectives. This review addresses potential errors in the detection and diagnosis of atrial tachyarrhythmias, sometimes resulting in incorrect mode switches. The interpretation of PM-stored data of patients with atrial tachyarrhythmias and the results of trials of pace prevention and intervention can be better appreciated with more insight into the technical options and pitfalls. Results. Literature and clinical experience demonstrate that the correctness of PM-derived diagnosis of atrial tachyarrhythmias depends on 1) the sensitivity setting to detect the onset and perpetuation of atrial tachyarrhythmias frequently characterised by variable and low-voltage signals, 2) the rejection of far-field R wave sensing by the atrial sense amplifier, 3) the facility for verification of mode switches by a high-quality intracardiac registration of the nonmodified atrial electrogram. The configuration of the atrial lead also contributes to the diagnostic performance of the PM. Conclusion. Not only pacing algorithms and diverse technical PM features but also the atrial lead configuration are currently the limiting factors to the fully reliable, automated detection and diagnosis of atrial tachyarrhythmias. If these technical shortcomings can be improved, better signal processing will result. Then atrial pacing to prevent or suppress atrial tachyarrhythmias will be more justified. (Neth Heart J 2008;16:201-10.)     

Improved Cardiac Contractility of Human Recombinant Growth Hormone on the Congestive Heart Failure of Pig

1Introduction Congestiveheartfailureisamultipleaetiology,high prevalence,cardiovasculardisorderwithpoorprognosis. Medicaltreatmentofdilatedcardiomyopathyisaimedat alleviatingthesymptomsofheartfailure.Diuretics,ACE inhibitorsandbeta blockershavefavourableeffectson symptoms,exercisecapacityandmortality[1-3].Growth hormone(GH)andinsulin likegrowthfactor(IGF) 1 areinvolvedinseveralphysiologicalprocessessuchas thecontrolofmusclemassandfunction,bodycomposi tionandtheregulationofnutrientmetaboli…     

PACEMAKER OSCILLATIONS IN HEART AND BRAIN: A KEY ROLE FOR HYPERPOLARIZATION-ACTIVATED CATION CHANNELS

Rhythmic activity of single cells or multicellular networks is a common feature of all organisms. The oscillatory activity is characterized by time intervals of several seconds up to many hours. Cellular rhythms govern the beating of the heart, the swimming behavior of sperm, cycles of sleep and wakefulness, breathing, and the release of hormones. Many neurons in the brain and cardiac cells are characterized by endogenous rhythmic activity, which relies on a complex interplay between several distinct ion channels. In particular, one type of ion channel plays a prominent role in the control of rhythmic electrical activity since it determines the frequency of the oscillations. The activity of the channels is thus setting the “pace” of the oscillations; therefore, these channels are often referred to as “pacemaker” channels. Despite their obvious important physiological function, it was not until recently that genes encoding pacemaker channels have been identified. Because both hyperpolarization and cyclic nucleotides are key elements that control their activity, pacemaker channels have now been designated hyperpolarization-activated and cyclic nucleotide–gated (HCN) channels. The molecular identification of the channels and the upcoming studies on their properties in heterologous systems will certainly enhance our understanding of “pacemaking” in physiological systems. This review gives a brief insight into the physiological importance of these channels and sums up what we have learned since the first cloning of genes succeeded (for recent reviews, see also Clapham 1998; Luüthi and McCormick 1998a; Biel et al. 1999; Ludwig, Zong, Hofmann, et al. 1999; Santoro and Tibbs 1999). (Chronobiology International, 17(4), 453–469, 2000)     

Location and functional characterization of the right atrioventricular pacemaker ring in the adult avian heart

Previous histological studies showed that in addition to a sinus node, an atrioventricular (AV) node, an AV bundle, left and right bundle branches, birds also possess a right AV‐Purkinje ring that is located in the atrial sheet of the right muscular AV‐valve along all its base length. The functionality of the AV‐Purkinje ring is unknown. In this work, we studied the topology of pacemaker myocytes in the atrial side of the isolated chicken spontaneously contracting right muscular AV‐valve using the method of microelectrode mapping of action potentials. We show that AV‐cells having the ability to show pacemaking reside in the right muscular AV‐valve. Pacemaker action potentials were exclusively recorded close to the base of the valve along its whole length from dorsal to the ventral attachment to the interventricular septum. These action potentials have much slower rate of depolarization, lower amplitude, and higher diastolic depolarization than action potentials of Purkinje (conducting) cells. We conclude the right AV‐valve has a ring bundle of pacemaker cells (but not Purkinje cells) in the adult chicken heart. J. Morphol. 277:363–369, 2016. © 2015 Wiley Periodicals, Inc.