LETHAL ARRHYTHMIAS RESULTING FROM MYOCARDIAL ISCHEMIA AND INFARCTION DEVELOPMENTS IN CARDIOVASCULAR MEDICINE Reiber, J.H.C., Serruys, P.W., Slager, C.].: Quantitative coronary and left ventricular cinean giography. ISBN 0-89838-760-4. Fagard, RH., Bekaert, I.E., eds.: Sports cardiology. ISBN 0-89838-782-5. Reiber, J.H.C., Serruys, P.W., eds.: State of the art in quantitative coronary arteriography. ISBN 0-89838-804-X. Roelandt, J., ed.: Color doppler flow imaging. ISBN 0-89838-806-6. van de Wall, E.E., ed.: Noninvasive imaging· of cardiac metabolism. ISBN 0-89838-812-0. Liebman,]., Plonsey, R., Rudy, Y., eds.: Pediatric and fundamental electrocardiography. ISBN 0-89838-815-5. Higler, H., Hombach, V., eds.: Invasive cardiovascular therapy. ISBN 0-89838-818-X. Serruys, P.W., Meester, G.T., eds.: Coronary angioplasty: a controlled model for ischemia. ISBN 0-89838-819-8. Tooke, ].E., Smaje, L.H., eds.: Clinical investigation of the microcirculation. ISBN 0-89838- 833-3. van Dam, Th., van Oosterom, A., eds.: Electrocardiographic body surface mapping. ISBN 0-89838-834-1. Spencer, M.P., ed.: Ultrasonic diagnosis of cerebrovascular disease. ISBN 0-89838-836-8. Legato, M.]., ed.: The stressed heart. ISBN 0-89838-849-X. Safar, M.E., ed.: Arterial and venous systems in essential hypertension. ISBN 0-89838-857-0. Roelandt,]., ed.: Digital techniques in echocardiography. ISBN 0-89838-861-9. Dhalla, N.S., Singal, P.K., Beamish, R.E., eds.: Pathophysiology of heart disease. ISBN 0-89838-864-3. Dhalla, N.S., Pierce, G.N., Beamish, RE., eds.: Heart function and metabolism. ISBN 0- 89838-865-1. Dhalla, N.S., Innes, I.R, Beamish, RE., eds.: Myocardial ischemia. ISBN 0-89838-866-X. Beamish, RE., Panagia, V., Dhalla, N.S., eds.: Pharmacological aspects of heart disease. ISBN 0-89838-867 -8. Ter Keurs, H.E.D.]., Tyberg,]. V., eds.: Mechanics of the circulation. ISBN 0-89838-870-8. Sideman, S., Beyar, R., eds.: Activation metabolism and perfusion of the heart. ISBN 0-89838- 871-6. Aliot, E., Lazzara, R, eds.: Ventricular tachycardias. ISBN 0-89838-881-3. Schneeweiss, A., Schettler, G.: Cardiovascular drug therapy in the elderly. ISBN 0-89838-883- X. Chapman, ]. V., Sgalambro, A., eds.: Basic concepts in doppler echocardiography. ISBN 0- 89838-888-0. Chien, S., Dormandy,]., Ernst, E., Matrai, A., eds.: Clinical hemorheology. ISBN 0-89838- 807-4. Morganroth, ]., Moore, E. Neil, eds.: Congestive heart failure. ISBN 0-89838-955-0. Heintzen, P.H., Bursch, ].H., eds.: Progress in digital angiocardiography. ISBN 0-89838-965- 8. Scheinman, M., ed.: Catheter ablation of cardiac arrhythmias. ISBN 0-89838-967-4. Spaan, ].A.E., Bruschke, A.V.G., Gittenberger, A.C., eds.: Coronary circulation. ISBN 0- 89838-978-X. Bayes de Luna, A., ed.: Therapeutics in cardiology. ISBN 0-89838~981-X. Mirvis, D.M., ed.: Body Surface Electrocardiographic Mapping. ISBN 0-89838-983-6. Visser, c., Kan, G., Meltzer, R., eds.: Echocardiography in coronary artery disease. ISBN 0-89838-979-8. Singal, P.K., ed.: Oxygen Radicals in the Pathophysiology of Heart Disease. ISBN 0-89838- 375-7. Iwata, H., Lombardini, ].B., Segawa, T., eds.: Taurine and the heart. ISBN 0-89838- Mirvis, D.M., ed.: Body surface electrocariographic mapping. ISBN 0-89838-983-6. Morganroth, ]., Moore, E.N., eds.: Silent myocardial ischemia. ISBN 0-89838-380-3. LETHAL ARRHYTHMIAS RESULTING FROM MYOCARDIAL ISCHEMIA AND INFARCTION [PROCEEDINGS OF THE SECOND RAPPAPORT SYMPOSIUM] EDITED BY MICHAEL R. ROSEN and YORAM PALTI ~. " KLUWER ACADEMIC PUBLISHERS GROUP BOSTONI DORDRECHT ILANCASTER Copyright 1989 by Kluwer Academic Publishers Softcover reprint of the hardcover 1s t edition 1989 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, mechanical, photocopying, recording, or other wise, without the prior written permission of the publisher, Kluwer Academic Publishers, 101 Philip Drive, Assinippi Park, Norwell, Massachusetts 02061. Distributors for North America: Kluwer Academic Publishers 101 Philip Drive Assinippi Park Norwell, Massachusetts 02061 USA Distributors for the UK and Ireland: Kluwer Academic Publishers Falcon House, Queen Square Lancaster LAI lRN, UNITED KINGDOM Distributors for all other countries: Kluwer Academic Publishers Group Distribution Centre Post Office Box 322 3300 AH Dordrecht, THE NETHERLANDS Library of Congress Cataloging-in-Publication Data Rappaport Symposium (2nd: 1988: Haifa, Israel) Lethal arrhythmias resulting from myocardial ischemia and infarction: proceedings of the Second Rappaport Symposium/edited by Michael R. Rosen, Yoram Palti. p. cm. - (Developments in cardiovascular medicine) Symposium held in Haifa, Israel, March 13-16, 1988. Includes bibliographies and index. ISBN-13: 978-1-4612-8916-6 e-ISBN-13: 978-1-4613-1649-7 DOl: 10.1007/978-1-4613-1649-7 1. Arrhythmia-Congresses. 2. Heart-Infarction-Complications and sequelae Congresses. 3. Ischemia-Complications and sequelae-Congresses. I. Rosen, Michael R. (Michael Robert), 1938- . 11. Palti, Yoram. 111. Title. IV. Series. [DNLM: 1. Arrhythmia-etiology-congresses. 2. Coronary Disease-complications -congresses. 3. Heart Arrest-congresses. 4. Myocardial Infarction-complications congresses. WI DE997VME/WG 330 R221 1988L] RC685.A65R27 1988 616.1'28-dc19 DNLMIDLC for Library of Congress This volume is dedicated to those who made the symposium possible: the investigators, who generously donated their time and shared their intellect, and the Rappaport family, who graciously supported the enterprise. CONTENTS Participants in the symposium IX Editors' Introductions xv I. IONIC DETERMINANTS OF ELECTRICAL ACTIVITY 1 1. Calcium current and excitation-contraction coupling in heart. 3 w. JONATHAN LEDERER, J.R. BERLIN, N.M. COHEN, e.G. NICHOLS, G.L. SMITH AND M.B. CANNELL 2. Role of cytosolic calcium in the normal and ischemic heart: potential 13 new insights from the second generation indicator, Indo-I. WILLIAM T. CLUSIN, RAJENDRA MOHABIR AND HON-CHI LEE 3. Repetitive activity: origin of the Na + load and its physiologic effects. 31 IRA S. COHEN, FANG CHANG AND RICHARD P. KLINE 4. Ionic changes associated with acute ischemia. 41 LEONARD S. GETTES, TIMOTHY A. JOHNSON, WILLIAM F. FLEET AND ICHIRO WATANABE 5. Mechanisms of reperfusion arrhythmias. 55 HAROLD C. STRAUSS, RAYMOND YEE, JOSEPH A. HILL, JR. AND THOMAS L. WENGER II. METABOLIC FACTORS IN ISCHEMIA 75 6. Ischemia and N a + IK + pump function. 77 ANDRE G. KLEBER AND WAYNE E. CASCIO 7. Amphipathic lipid metabolites and arrhythmogenesis: a perspective. 91 PETER B. CORR AND DAVID J. DOBMEYER 8. Free radicals and myocardial injury during ischemia and reperfusion: 105 a short-lived phenomenon? DAVID J. HEARSE 9. Thyroid hormones and cardiac function. 117 OFER BINAH, IRIT RUBINSTEIN, BELLA FELZEN, YECHIEL SWEED AND SELA MAGER vii viii Contents III. NEURAL AND HORMONAL FACTORS 129 10. Receptor mechanisms in ischemia and infarction. 131 AUGUST M. WATANABE 11. Sympathetic-parasympathetic interactions in the normal heart. 137 MATTHEW N. LEVY 12. Central nervous system modulation of cardiac rhythm. 149 RICHARD L. VERRIER 13. Influence of ischemia and infarction on cardiac vagal and sympathetic 165 innervation. DOUGLAS P. ZIPES IV. ARRHYTHMOGENIC MECHANISMS 179 14. On the problem of anisotropic propagation in ventricular muscle. 181 MARIO DELMAR, CARMEN DELGADO, DANTE CHIALVO, DONALD C. MICHAELS AND JOSE JALIFE 15. Anisotropic reentry: A model of arrhythmias that may necessitate a new 199 approach to antiarrhythmic drug development. ANDREW L. WIT 16. Arrhythmias in the early ischemic period. 215 MICHIEL J. JANSE 17. Arrhythmias and the healed myocardial infarction. 229 ROBERT J. MYERBURG, SHINICHI KIMURA, PATRICIA L. KOZLOVSKIS, ARTHUR L. BASSETT, HEIKKI HUIKURI AND AGUSTIN CASTELLANOS V. STRATEGIES FOR PREDICTION, PREVENTION AND THERAPY 243 18. Clinical significance and limitations of ventricular late potentials. 245 GUNTER BREITHARDT, MARTIN BORGGREFE, ULRICH KARBENN AND ANTONI MARTINEZ-RUBIO 19. Pacing to predict mechanism: transient entrainment and reentry. 255 ALBERT L. WALDO AND RICHARD W. HENTHORN 20. The value of programmed electrical stimulation in triggered 269 activity-induced arrhythmias. ANTON P.M. GORGELS, MARC A. VOS, PEDRO BRUGADA AND HEIN J.J. WELLENS 21. Pharmacologic mechanisms in the treatment of arrhythmias due to 281 ischemia and infarction. BRIAN F. HOFFMAN AND WALTER SPINELLI 22. Cardiac innervation and sudden death: new strategies for 293 prevention. PETER J. SCHWARTZ PARTICIPANTS IN THE SYMPOSIUM Ofer Binah, Ph.D. Departments of Biophysics and Physiology Rappaport Family Institute for Research in the Medical Sciences Technion-Israel Institute of Technology Faculty of Medicine Efron Street-Post Office Box 9697 Haifa 31096 Israel Dr. Gunter Breithardt Professor of Medicine (Cardiology) Direktor Medizinische Klinik und Poliklinik Innere Medizin C Westfalische Wilhelms Universitat Munster Albert-Schweitzer-Strabe 33 D-4400 Munster West Germany William Clusin, M. D., Ph. D. Assistant Professor of Medicine and Physiology Falk Cardiovascular Research Center Stanford University School of Medicine 300 Pasteur Drive Stanford, California 94305 ix x Contributing Authors Ira S.Cohen, M.D., Ph.D. Professor of Physiology and Biophysics Health Sciences Center State University of New York at Stony Brook Stony Brook, New York 11794 Peter B. Corr, Ph.D. Associate Professor of Medicine and Pharmacology Department of Internal Medicine Cardiovascular Division Washington University School of Medicine 660 South Euclid A venue St. Louis, Missouri 63110 Leonard S. Gettes, M.D. Director, Divison of Cardiology University of North Carolina at Chapel Hill 349 Clinical Sciences Building, 229-H Chapel Hill, North Carolina 27514 Dr. David J. Hearse Professor The Rayne Institute The Medical School St. Thomas' Hospital London SE 1 7EH England Dr. Anton P.M. Gorgels Experimentele Cardiologie Academisch Rijksuniversiteit Limburg Annadal1 Maastricht 6201BX The Netherlands Brian Hoffman, M.D. David Hosack Professor and Chairman Department of Pharmacology College of Physicians and Surgeons Columbia University 630 West 168th Street New York, New York 10032 xi Jose Jalife, M.D. Professor Department of Pharmacology College of Medicine State University of New York Health Science Center 766 Irving A venue Syracuse, New York 13210 Dr. MichielJ. Janse Professor Klinische en Experimentele Cardiologie Academisch Ziekenhuis Bij de Universiteit van Amsterdam Academisch Medisch Centrum Meibergdreef 9 1105 AZ Amsterdam The Netherlands Dr. Andre G. Kleber Physiologisches Institut Universitat Bern Buehlplatz 5 3012 Bern Switzerland W. Jonathan Lederer, M.D., Ph.D. Associate Professor Department of Physiology University of Maryland School of Medicine 660 West Redwood Street Baltimore, Maryland 21201 Matthew N. Levy, M.D. Chief, Investigative Medicine The Mt. Sinai Medical Center One Mt. Sinai Drive Cleveland, Ohio 44106
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