The Animal Experimental And Clinical Study Of Arrhythmias Induced By Coronary Artery Spasm

[Objective] To evaluate the method of creating coronary artery spasm (CAS) in porcines by intracoronary injection of ergonovine and the arrhythmia events possibly induced by CAS.[Methods] 18 porcines were randomly divided into trial group(n=10)and control group(n=8).All porcines were anesthetized and put percutaneous transluminlar coronary angioplasty balloon via right femoral artery under fluoroscopic guide to the debouchement of left anterior desending coronary artery(LAD), and porcines in trial group were infused with ergonovine (0.3mg/kg) while porcines in control group infused with physiologic saline.[Results] ST segment elevation was demonstrated in anterior-chest ECG leads in all porcines of trial group. Severe ventricular arrhythmias occurred in 4 animals of trial group, including frequently ventricular premature contraction in 2 animals, ventricular premature contraction and nosustained ventricular tachycardia in 1, and sustained ventricular tachycardia,ventricular flutter and ventricular fibrillation in 1 animal. Coronary angiography showed LAD stenosis induced by CAS in 8 and complete occlusion in 2 animals; All animals in control group showed no change by coronary angiography.[Conclusion] The method of intracoronary injection of ergonovine may present a simple and convenient way to establish CAS model in porcines, and CAS may induce ventricular tachycardia arrhythmias.Part II The clinical characteristics and management of arrhythmias induced by coronary artery spasm[Objective] To assess the clinical characteristics,mechanism and management of arrhythmias induced by coronary artery spasm(CAS).[Methods] 12-lead Electrocardiogram,arrhythmia monitor and Holter were employed to record the episode of chest pain in these 13 patients with variant angina(VA).[Result] Critical arrhythmias and ST-segment elevation induced by CAS were detected during chest pain in all patients, including frequent ventricular premature beat in 1 patient, nosustained ventricular tachycardia in 2 patients, sustained ventricular tachycardia in 2 patient, III°AVB in 3 patients, III°AVB,sustained ventricular tachycardia and ventricular fibrillation in 1 patient, sinus arrest,nosustained ventricular tachycardia in 1 patient, sustained ventricular tachycardia,ventricular fibrillation in 3 patients. Cardiac syncope occurred in all patients except 2 patients with nosustained ventricular tachycardia,1 patient with III°AVB and 1 patient with ventricular premature beat. Coronary angiography showed CAS occurring in 1 patient,coronary stenosis related to ischemia occurring in 8 patients and coronary artery normal in 4 patients. All patients were given drug, 3 patients were implanted with intracoronary stents, and 1 patient died.[Conclusion] CAS basing on or no coronary artery affection may induce bradycardia and (or) ventricular tachycardia arrhythmias. It is very essential to take related therapy to patients with coronary artery affection, under the prerequisite of effectively anti-CAS.