- 著者
- TOYAMA J. HONJO HARUO OSAKA TOSHIYUKI ANNO TAKAFUMI HIRAI MAKOTO OHTA TOSHIKI KODAMA ITSUO YAMADA KAZUO
- 出版者
- 社団法人日本循環器学会
- 雑誌
- Jpn. Circ. J. (ISSN:00471828)
- 巻号頁・発行日
- vol.51, pp.163-171, 1987
- 被引用文献数
- 1
In order to clarify the role of Purkinje fibers in the occurrence of reperfusion arrhythmias, endocardial mapping was performed on perfused canine hearts by attaching 42 close bipolar electrodes to the endocardial surface of the left ventricular septum. Reperfusion with oxygenated Krebs-Ringer solution following 30 min of coronary occulusion induced ventricular tachycardia (VT) in 14 out of 23 preparations. These VT degenerated into ventricular fibrillation (VF) within 1 min after the reperfusion in all but 3 cases. Endocardial mapping revealed that the excitations during VT were always initiated by the Purkinje activities and that myocardial excitations were expanded in a centrifugal manner through Purkinje-muscle junctional area. Furthermore, this excitation pattern was preserved, in the early phase of VT, even though the propagation pattern was distorted. VF was always induced by reperfusion following 30 min of ischemic condition, that is, coronary perfusion with a hyperkalemic (K=10 mM), acidic (pH=6.8) and hypoxic (PO_2=20-40 mmHg) solution (4/4 cases). Elimination of hyperkalemia from the ischemic condition markedly prevented occurrence of VF (1/6 cases) during reperfusion but it did not affect occurrence of VT (4/6 cases); this implies that hyperkalemia causes the onset of VF but has less effect on the occurrence of VT. It has been separately confirmed by micro-electrode experiment, using the dissected papillary muscle of the canine right ventricle, that abnormal impulse formation during re-oxygenation was triggered in Purkinje fibers around Purkinje-muscle junction.
- 著者
- Yamashita Takeshi Ogawa Satoshi Aizawa Yoshifusa Atarashi Hirotsugu Inoue Hiroshi Ohe Tohru Okumura Ken Kato Takao Kamakura Shiro Kumagai Koichiro Kurachi Yoshihisa Kodama Itsuo Koretsune Yukihiro Saikawa Tetsunori Sakurai Masayuki Sugi Kaoru Nakaya Haruaki Nakayama Toshio Hirai Makoto Fukatani Masahiko Mitamura Hideo Yamazaki Tsutomu
- 出版者
- 社団法人日本循環器学会
- 雑誌
- Circulation journal : official journal of the Japanese Circulation Society (ISSN:13469843)
- 巻号頁・発行日
- vol.67, no.9, pp.738-741, 2003-08-20
- 被引用文献数
- 22 50
The Japanese Rhythm Management Trial for Atrial Fibrillation (J-RHYTHM study) is a randomized comparative evaluation of rate control and rhythm control, both combined with antithrombotic therapy, as therapeutic strategies for the treatment of atrial fibrillation (AF). This study differs from the earlier AFFIRM and RACE studies in that it has a composite primary end-point representing mortality and also physical/psychological disablement (total mortality, symptomatic cerebral infarction, systemic embolism, major bleeding, hospitalization for heart failure requiring intravenous administration of diuretics, and patient disablement). Patients' will to change the therapeutic strategy to the other is also considered as an end-point representing disablement under the assigned strategy. The secondary end-point includes quality of life scores and the efficacy and safety of drugs used in treating AF. The J-RHYTHM study emphasizes patient-reported experience and perception of AF-specific disablement, and the safety of antiarrhythmics available in Japan; it will follow 2,600 patients treated at more than 150 sites in Japan for a 3-year period. (Circ J 2003; 67: 738-741)