Hypothermia Modulates Arrhythmia Substrates During Different Phases of Resuscitation From Ischemic Cardiac Arrest
BackgroundWe designed an innovative porcine model of ischemia‐induced arrest to determine dynamic arrhythmia substrates during focal infarct, global ischemia from ventricular tachycardia or fibrillation (VT/VF) and then reperfusion to determine the effect of therapeutic hypothermia (TH) on dynamic a...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2017-11-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.117.006472 |
| _version_ | 1819183268559323136 |
|---|---|
| author | Joseph S. Piktel Aurelia Cheng Matthew McCauley Zack Dale Michelle Nassal Danielle Maleski Gary Pawlowski Kenneth R. Laurita Lance D. Wilson |
| author_facet | Joseph S. Piktel Aurelia Cheng Matthew McCauley Zack Dale Michelle Nassal Danielle Maleski Gary Pawlowski Kenneth R. Laurita Lance D. Wilson |
| author_sort | Joseph S. Piktel |
| collection | DOAJ |
| description | BackgroundWe designed an innovative porcine model of ischemia‐induced arrest to determine dynamic arrhythmia substrates during focal infarct, global ischemia from ventricular tachycardia or fibrillation (VT/VF) and then reperfusion to determine the effect of therapeutic hypothermia (TH) on dynamic arrhythmia substrates and resuscitation outcomes. Methods and ResultsAnesthetized adult pigs underwent thoracotomy and regional plunge electrode placement in the left ventricle. Subjects were then maintained at either control (CT; 37°C, n=9) or TH (33°C, n=8). The left anterior descending artery (LAD) was occluded and ventricular fibrillation occurred spontaneously or was induced after 30 minutes. Advanced cardiac life support was started after 8 minutes, and LAD reperfusion occurred 60 minutes after occlusion. Incidences of VF/VT and survival were compared with ventricular ectopy, cardiac alternans, global dispersion of repolarization during LAD occlusion, and LAD reperfusion. There was no difference in incidence of VT/VF between groups during LAD occlusion (44% in CT versus 50% in TH; P=1s). During LAD occlusion, ectopy was increased in CT and suppressed in TH (33±11 ventricular ectopic beats/min versus 4±6 ventricular ectopic beats/min; P=0.009). Global dispersion of repolarization and cardiac alternans were similar between groups. During LAD reperfusion, TH doubled the incidence of cardiac alternans compared with CT, with a marked increase in VF/VT (100% in TH versus 17% in CT; P=0.004). Ectopy and global dispersion of repolarization were similar between groups during LAD reperfusion. ConclusionsTH alters arrhythmia substrates in a porcine translational model of resuscitation from ischemic cardiac arrest during the complex phases of resuscitation. TH worsens cardiac alternans, which was associated with an increase in spontaneous VT/VF during reperfusion. |
| first_indexed | 2024-12-22T22:59:20Z |
| format | Article |
| id | doaj.art-e154bd94adf744a88ad85044c3f2b4b0 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T22:59:20Z |
| publishDate | 2017-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-e154bd94adf744a88ad85044c3f2b4b02022-12-21T18:09:44ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802017-11-0161110.1161/JAHA.117.006472Hypothermia Modulates Arrhythmia Substrates During Different Phases of Resuscitation From Ischemic Cardiac ArrestJoseph S. Piktel0Aurelia Cheng1Matthew McCauley2Zack Dale3Michelle Nassal4Danielle Maleski5Gary Pawlowski6Kenneth R. Laurita7Lance D. Wilson8Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, OHHeart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, OHHeart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, OHHeart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, OHHeart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, OHHeart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, OHHeart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, OHHeart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, OHHeart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, OHBackgroundWe designed an innovative porcine model of ischemia‐induced arrest to determine dynamic arrhythmia substrates during focal infarct, global ischemia from ventricular tachycardia or fibrillation (VT/VF) and then reperfusion to determine the effect of therapeutic hypothermia (TH) on dynamic arrhythmia substrates and resuscitation outcomes. Methods and ResultsAnesthetized adult pigs underwent thoracotomy and regional plunge electrode placement in the left ventricle. Subjects were then maintained at either control (CT; 37°C, n=9) or TH (33°C, n=8). The left anterior descending artery (LAD) was occluded and ventricular fibrillation occurred spontaneously or was induced after 30 minutes. Advanced cardiac life support was started after 8 minutes, and LAD reperfusion occurred 60 minutes after occlusion. Incidences of VF/VT and survival were compared with ventricular ectopy, cardiac alternans, global dispersion of repolarization during LAD occlusion, and LAD reperfusion. There was no difference in incidence of VT/VF between groups during LAD occlusion (44% in CT versus 50% in TH; P=1s). During LAD occlusion, ectopy was increased in CT and suppressed in TH (33±11 ventricular ectopic beats/min versus 4±6 ventricular ectopic beats/min; P=0.009). Global dispersion of repolarization and cardiac alternans were similar between groups. During LAD reperfusion, TH doubled the incidence of cardiac alternans compared with CT, with a marked increase in VF/VT (100% in TH versus 17% in CT; P=0.004). Ectopy and global dispersion of repolarization were similar between groups during LAD reperfusion. ConclusionsTH alters arrhythmia substrates in a porcine translational model of resuscitation from ischemic cardiac arrest during the complex phases of resuscitation. TH worsens cardiac alternans, which was associated with an increase in spontaneous VT/VF during reperfusion.https://www.ahajournals.org/doi/10.1161/JAHA.117.006472arrhythmiahypothermiamyocardial infarctionresuscitationventricular fibrillation |
| spellingShingle | Joseph S. Piktel Aurelia Cheng Matthew McCauley Zack Dale Michelle Nassal Danielle Maleski Gary Pawlowski Kenneth R. Laurita Lance D. Wilson Hypothermia Modulates Arrhythmia Substrates During Different Phases of Resuscitation From Ischemic Cardiac Arrest Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease arrhythmia hypothermia myocardial infarction resuscitation ventricular fibrillation |
| title | Hypothermia Modulates Arrhythmia Substrates During Different Phases of Resuscitation From Ischemic Cardiac Arrest |
| title_full | Hypothermia Modulates Arrhythmia Substrates During Different Phases of Resuscitation From Ischemic Cardiac Arrest |
| title_fullStr | Hypothermia Modulates Arrhythmia Substrates During Different Phases of Resuscitation From Ischemic Cardiac Arrest |
| title_full_unstemmed | Hypothermia Modulates Arrhythmia Substrates During Different Phases of Resuscitation From Ischemic Cardiac Arrest |
| title_short | Hypothermia Modulates Arrhythmia Substrates During Different Phases of Resuscitation From Ischemic Cardiac Arrest |
| title_sort | hypothermia modulates arrhythmia substrates during different phases of resuscitation from ischemic cardiac arrest |
| topic | arrhythmia hypothermia myocardial infarction resuscitation ventricular fibrillation |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.117.006472 |
| work_keys_str_mv | AT josephspiktel hypothermiamodulatesarrhythmiasubstratesduringdifferentphasesofresuscitationfromischemiccardiacarrest AT aureliacheng hypothermiamodulatesarrhythmiasubstratesduringdifferentphasesofresuscitationfromischemiccardiacarrest AT matthewmccauley hypothermiamodulatesarrhythmiasubstratesduringdifferentphasesofresuscitationfromischemiccardiacarrest AT zackdale hypothermiamodulatesarrhythmiasubstratesduringdifferentphasesofresuscitationfromischemiccardiacarrest AT michellenassal hypothermiamodulatesarrhythmiasubstratesduringdifferentphasesofresuscitationfromischemiccardiacarrest AT daniellemaleski hypothermiamodulatesarrhythmiasubstratesduringdifferentphasesofresuscitationfromischemiccardiacarrest AT garypawlowski hypothermiamodulatesarrhythmiasubstratesduringdifferentphasesofresuscitationfromischemiccardiacarrest AT kennethrlaurita hypothermiamodulatesarrhythmiasubstratesduringdifferentphasesofresuscitationfromischemiccardiacarrest AT lancedwilson hypothermiamodulatesarrhythmiasubstratesduringdifferentphasesofresuscitationfromischemiccardiacarrest |