DOI: 10.1101/468710Nov 12, 2018Paper

Ischemic Preconditioning and Left Ventricular Dysfunction: A Novel Mechanism & Model for Pulseless Electrical Activity

BioRxiv : the Preprint Server for Biology
Kaustubha D PatilHenry R Halperin

Abstract

Background Pulseless electrical activity (PEA) is a very common rhythm in cardiac arrest and survival is ≈ 5%. Population data suggest coronary ischemia significantly contributes to PEA, but the mechanism is unknown. Objectives We hypothesize ischemic preconditioning (IPC) in the setting of left ventricular (LV) dysfunction can convert ischemia-induced ventricular fibrillation (VF) into ischemia-induced PEA. Methods Using percutaneous coronary interventions in anesthetized swine, we studied the effect of IPC prior to ischemia on arrhythmic burden in normal animals and in animals with LV dysfunction. IPC protocol: four cycles of three minutes of coronary occlusion followed by seven minutes of reperfusion. Chronic LV dysfunction protocol: two serial infarcts in two coronary territories, separated by one week of recovery. Results In normal animals, IPC prior to ischemia significantly reduced VF incidence (2/8 IPC vs. 7/8 control). In IPC animals with VF, the time to VF was significantly delayed (37.2 ± 7.3 min vs. 20.7 ± 4.9 min, p<0.005). In chronic LV dysfunction animals (EF 15% ± 5%), ischemia caused PEA in all animals (18/18). In non-preconditioned animals, VF followed PEA in all cases (12/12). In preconditioned animals, PEA s...Continue Reading

Related Concepts

Electric Stimulation Technique
Heart
Cardiac Arrest
Infarction
Ischemia
Ventricular Fibrillation
Coronary Occlusion
Left Ventricular Structure
Ventricular Dysfunction, Left
Electromechanical Dissociation

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