DISPARATE ELECTROPHYSIOLOGICAL ALTERATIONS ACCOMPANYING DYSRHYTHMIA DUE TO CORONARY-OCCLUSION AND REPERFUSION IN CAT

The electrophysiologic changes associated with dysrhythmias induced by coronary occlusion and by subsequent reperfusion were characterized with six complimentary approaches in chloralose-anesthetized cats (n=57) with proximal occlusion of the left anterior descending (LAD) coronary artery. Occlusion led to reproducible ventricular dysrhythmia which abated in 35 minutes. The electrophysiologic effects of reperfusion initiated at this time could be studied. Simultaneous bipolar electrograms (epi-, myo- and endocardial) from ischemic and normal zones were analyzed by computer. Before the onset of the dysrhythmia induced by occlusion, conduction was markedly slowed, with dV/dt decreasing to 34% ± 6% of control and conduction time (endo- to epicardial activation) prolonged to 328 ± 77% of control. However, these values returned toward normal with reperfusion, even though it also consistently induced dysrhythmia. The idioventricular escape rate (determined by intense vagal stimulation) was 62 ± 6 beats/min during the dysrhythmia induced by occlusion (equal to control), but increased during the reperfusion dysrhythmia to 188 ± 12 beats/min. The occlusion dysrhythmia was exacerbated, but the reperfusion dysrhythmia was suppressed by rapid atrial pacing. The refractory period progressively shortened after occlusion and remained decreased during early reperfusion. Thus, increased conduction time through myocardial and epicardial regions, asynchronous depolarization and shortening of the refractory period accompanied dysrhythmia induced by occlusion. In contrast, the dysrhythmia induced by reperfusion was characterized by normal conduction time, through myocardial regions with continued significant epicardial delay, overdrive suppression, synchronous depolarization and a high idioventricular rate.