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Catecholamine-Dependent Cardiac Arrhythmias: Mechanisms and Implications

  • S. G. Priori
  • P. J. Schwartz
Conference paper

Abstract

Although the arrhythmogenic role of sympathetic activation acting over an ischemic substrate has been established [1, 2], the mechanisms involved remain largely speculative. In fact, due to their electrophysiologic properties, catecholamines influence several determinants of cardiac excitability thus creating a rather complex picture which is difficult to unravel. This complexity is largely due to the fact that adrenergic activation, besides acting on the electrophysiologic characteristics of the heart, affects most cardiac functions such as contractility, metabolism, and coronary circulation. Furthermore, depending on the substrate on which catecholamines are released, i.e., whether the heart is normally perfused or acutely ischemic or has suffered a myocardial infarction, the consequences of adrenergic activation can vary.

Keywords

Purkinje Fiber Trigger Activity Cardiac Sympathetic Nerve Adrenergic Activation Coupling Interval 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Schwartz PJ, Stone HL (1982) The role of the autonomic nervous system in sudden coronary death. Ann N Y Acad Sci 382:162–180.PubMedCrossRefGoogle Scholar
  2. 2.
    Corr PB, Yamada KA, Witkoswki FX (1986) Mechanisms controlling cardiac autonomie function and their relation to arrhythmogenesis. In: Fozzard HA, Haber E, Jennings RB, Katz AM, Morgan HE (eds) The heart and the cardiovascular system. New York, pp 1343-1404.Google Scholar
  3. 3.
    Toda N, Shimamoto K (1968) The influence of sympathetic stimulation on transmembrane potentials in the SA node. J Pharmacol Exp Ther 159:289–305.Google Scholar
  4. 4.
    Giotti A, Ledda F, Mannaioni PF (1973) Effects of noradrenaline and isoprenaline, in combination with alpha and beta receptor bloking sustances, on the action potential of cardiac Purkinje fibers. J Physiol (Lond) 229:99–113.Google Scholar
  5. 5.
    Rosen MR, Hordof AJ, Ilvento JP, Danilo P (1977) Effects of adrenergic amines on electro-physiological properties and automaticity of neonatal and adult canine Purkinje fibers. Evidence of alpha and beta-adrenergic actions. Circ Res 40:390–400.PubMedGoogle Scholar
  6. 6.
    Hope RR, Williams DO, El-Sherif N, Lazzara R, Scherlag BJ (1974) The efficacy of antiarrhythmic agents during acute myocardial ischemia and the role of heart rate. Circulation 50:507–514.PubMedGoogle Scholar
  7. 7.
    Pappano A, Carmeliet EE (1979) Epinephrine and the pacemaking mechanisms at the plateau potentials in sheep cardiac Purkinje fibers. Pflugers Arch 382:17–26.PubMedCrossRefGoogle Scholar
  8. 8.
    Li T, Sperelakis N (1983) Stimulation of slow action potentials in guinea pig papillary muscle cells by intracellular injection of CAMP, Gpp (NH)p, and cholera toxin. Circ Res 52:111–117.PubMedGoogle Scholar
  9. 9.
    Janse MJ, Schwartz PJ, Wilms-Skopman F, Peters RJG, Durrer D (1985) Effects of unilateral stellate ganglion stimulation and ablation on electrophysiologic changes induced by acute myocardial infarction in dogs. Circulation 72:585–595.PubMedCrossRefGoogle Scholar
  10. 10.
    El-Sherif N (1978) Reentrant ventricular arrhythmias in the late myocardial infarction period. Effect of the autonomic nervous system. Circulation 58:103–109.PubMedGoogle Scholar
  11. 11.
    Wallace AG, Sarnoff SJ (1986) Effects of cardiac sympathetic stimulation on conduction in the heart. Circ Res 14:86.Google Scholar
  12. 12.
    Gelband H, Rosen MR, Myerburg MJ, Bush HL, Bassett A, Hoffman BF (1977) Restorative effect of epinephrine on the electrophysiologic properties of depressend human atrial tissue. J Electrocardiol 10(4):313.PubMedCrossRefGoogle Scholar
  13. 13.
    Vassalle M, Bernabel O (1971) Norepinephrine and potassium in cardiac fibers. Pflugers Arch 322:287.PubMedCrossRefGoogle Scholar
  14. 14.
    Arita M, Kiyosue T, Aomina M, Imanishi S (1983) Nature of “residual fast channel” dependent action potentials and slow conduction in guinea pig ventricular muscle and its modification by isoproterenol. Am J Cadiol 51:1433–1440.CrossRefGoogle Scholar
  15. 15.
    Rosen MR, Hordof AJ, Ilvento JP, Danilo P (1977) Effects of adrenergic amines on electro-physiological properties and automaticity of neonatal and adult canine Purkinje fibers. Evidence for alpha and beta-adrenergic actions. Circ Res 40:390–400.PubMedGoogle Scholar
  16. 16.
    Han J, Moe GK (1964) Nonuniform recovery of excitability in ventricular muscle. Circ Res 14:44–60.PubMedGoogle Scholar
  17. 17.
    Kraios FA, Martin L, Burgess MJ, Millar K (1975) Local ventricular repolarization changes due to sympathetic nerve-branch stimulation. Am J Physiol 228:1621–1626.Google Scholar
  18. 18.
    Kimura S, Cameron JS, Kozlovskis PL, Bassett AL, Myerburg RJ (1984) Delayed afterdepolarizations and triggered activity induced in feline Purkinje fibers by alpha-adrenergic Stimulation in the presence of elevated calcium. Circulation 70:1074.PubMedCrossRefGoogle Scholar
  19. 19.
    Marchi S, Meier C, Lazzara R (1987) Adrenergic induction of afterdepolarizations in canine myocites. Circulation 76:11–427.Google Scholar
  20. 20.
    Wit AL, Rosen MR (1986) Afterdepolarizations and triggered activity. In: Fozzard HA, Haber E, Jennings RB, Katz AM, Morgan HE (eds) The heart and the cardiovascular system. Raven, New York, pp 1449–1490.Google Scholar
  21. 21.
    Pogwizd SM, Corr PB (1987) Reentrant and nonreentrant mechanisms contribute to arrhythmogenesis during early myocardial ischemia: results using three-dimensional mapping. Circ Res 61:353–371.Google Scholar
  22. 22.
    Schwartz PJ, Vanoli E, Zaza A, Zuanetti G (1985) The effect of antiarrhythmic drugs on life threatening arrhythmias induced by the interaction between acute ischemia and sympathetic hyperactivity. Am Heart J 109:937–948.PubMedCrossRefGoogle Scholar
  23. 23.
    Schwartz PJ, Priori SG, Vanoli E, Zaza A, Zuanetti G (1986) Efficacy of dilizatem in two feline experimental models of sudden cardiac death. J Am Coll Cardiol 8:661–668.PubMedCrossRefGoogle Scholar
  24. 24.
    Priori SG, Zuanetti G, Schwartz PJ (1988) Ventricular fibrillation induced by the interaction between acute myocardial ischemia and sympathetic hyperactivity: effect of nifedipine. Am Heart J 116:37–43.PubMedCrossRefGoogle Scholar
  25. 25.
    Arnsdorf MF, Wasserstrom JA (1985) Mechanism of action of antiarrhythmic drugs: a matricial approach. In: Fozzard HA, Haber E, Jennings RB, Katz AM, Morgan HE (eds) The heart and the cardiovascular system. Raven, New York, pp 1259–1316.Google Scholar
  26. 26.
    Levine JH, Spear JF, Guarnieri T, Wesfeldt ML, De Langen CDJ, Becker LC, Moore EN (1985) Cesium chloride induced long QT sundrome: demonstration of afterdepolarizations and triggered activity in vivo. Circulation 72:1092–1104.PubMedCrossRefGoogle Scholar
  27. 27.
    Priori SG, Mantica M, Schwart PJ (1988) Delayed afterdepolarizations elicited in vivo by left stellate ganglion stimulation. Circulation 72:178–185.CrossRefGoogle Scholar
  28. 28.
    Schwartz PJ (1984) The rationale and the role of left stellectomy for the prevention of malignant arrhythmias. Ann NY Acad Sci 427:199–221.PubMedCrossRefGoogle Scholar
  29. 29.
    Moss AJ, Schwartz PJ (1982) Delayed repolarization (QTor QT-U prolongation) and malignant ventricular arrhythmias. Mod Concepts Cardiovasc Dis 51:85–90.PubMedGoogle Scholar
  30. 30.
    Schwartz PJ (1985) Idiopatic long QT syndrome: progress and questions. Am Heart J 109:399–411.PubMedCrossRefGoogle Scholar
  31. 31.
    Schwartz PJ, Locati E (1985) The idiopathic long QT syndrome: pathogenetic mechanisms and therapy. Eur Heart J 6 [Suppl D]:103–114.PubMedGoogle Scholar
  32. 32.
    Schechter E, Freeman CC, Lazzara R (1984) Afterdepolarizations: a mechanism for the long QT syndrome: electrophysiologic studies of a case. J Am Cardiol 3:1556–1561.CrossRefGoogle Scholar
  33. 33.
    Hoffman BF, Cranefield PF (1986) Electrophysiology of the heart. McGraw-Hill, New York.Google Scholar
  34. 34.
    Szabo B, Patterson E, Scherlag B, Lazzara R (1987) Early afterdepolarizations induced by calcium are dependent on intra and extra-cellular (Ca + +) and (Na). Circulation 76:IV–115.Google Scholar
  35. 35.
    Hanich RF, Levine JH, Spear JF, Moore EN (1988) Autonomic modulation of ventricular arrhythmias in cesium-induced long QT syndrome. Circulation 77:1149–1161.PubMedCrossRefGoogle Scholar
  36. 36.
    Ben-David J, Gerbig NR, Zipes DP (1988) Differential response of early afterdepolarizations and ventricular tachycardia during right and left stellate stimulation in the dog treated with cesium. J Am Coll Cardiol 11(2):254A.Google Scholar
  37. 37.
    Jackman WM, Clark M, Friday KJ, Aliot EM, Anderson J, Lazzara R (1984) Ventricular tachyarrhythmias in the long QT syndrome. Med Clin North Am 68:1079–1109.PubMedGoogle Scholar
  38. 38.
    Schwartz PJ (1986) Prevention of the arrhythmias in the long QT syndrome. In: Kulbertus HE (ed) Medical management of cardiac arrhythmias. Churchill Livingstone, Edinburgh pp 153–162.Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1989

Authors and Affiliations

  • S. G. Priori
  • P. J. Schwartz

There are no affiliations available

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