Experimental prevention of sudden death from acute coronary artery occlusion in the dog

Milch, Elmer; Zimdahl, Walter T.; Egan, Richard; Hsia, Ting Wei; Anderson, Arthur A.; David, Joseph Ben

doi:10.1016/0002-8703(55)90295-7

Cited by 23 publications

(1 citation statement)

References 28 publications

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“…In 1955, Milch et al 22 found that the incidence of sudden death after ligation of the left anterior descending coronary artery in anesthetized dogs was reduced by bilateral thoracic sympathetic ganglionectomy to 39%, (compared with 62% in control dogs), and to 16% by injecting procaine in the left stellate ganglion.…”

Section: Arrhythmiasmentioning

confidence: 99%

Left stellectomy in the prevention of ventricular fibrillation caused by acute myocardial ischemia in conscious dogs with anterior myocardial infarction.

Schwartz¹,

Stone²

1980

Circulation

194

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SUMMARY The potential of left stellectomy in reducing the incidence of ventricular fibrillation associated with acute myocardial ischemia was investigated in a new animal model for sudden death. Thirty-two dogs had an anterior myocardial infarction produced by ligation of the left descending coronary artery. One week later they were randomly allocated to a control or to an experimental group that underwent left stellectomy. One month after ligation while the dogs were conscious, a balloon occluder previously positioned around the circumflex coronary artery was inflated and the ensuing coronary occlusion was maintained for 10 minutes. Ventricular fibrillation occurred in 11 of 17 (65%) control dogs, compared with five of 15 (33%) (p < 0.05) in the experimental group. Among the survivors the incidence of arrhythmias was less in the experimental group compared with the control group. Infarct size (21 ± 2% vs 20 ± 2%), resting heart rate (143 beats/min vs 127 beats/min) and QT, (347 ± 11 msec vs 349 13 msec) were similar between control and experimental groups.The dogs that died had a greater increase in heart rate at 1 minute postocclusion than survivors and also had significantly longer QT intervals.Our study indicates that left stellectomy exerts a major protective effect in reducing the incidence of ventricular fibrillation when conscious dogs with a previous anterior myocardial infarction undergo acute myocardial ischemia. This simple and safe surgical procedure may be considered for a clinical trial in subgroups of patients with ischemic heart disease at very high risk for sudden death.SUDDEN DEATH is most often caused by ventricular fibrillation.' The importance of neural mechanisms, particularly the sympathetic nervous system, in precipitating ventricular fibrillation has been shown experimentally, confirmed clinically and is generally accepted.2 7 Therefore, a rational approach toward the prevention of sudden death is represented by interventions that increase electrical stability and interfere with the effects of increases in sympathetic activity. We propose that left stellectomy may be one of these interventions.We have shown that ablation of the left stellate ganglion results in a reduced incidence of arrhythmias either directly or indirectly, by changes in hemodynamic variables relevant to the genesis of cardiac arrhythmias. Briefly, left stellectomy reduces the incidence of arrhythmias associated with transient coronary occlusion,8 markedly increases the threshold for ventricular fibrillation,9 prolongs the ventricular refractory period,'0 and increases the capability of the coronary bed to dilate at rest" and during exercise.12Two considerations have guided the design of our experimental model: (1) Patients with a previous anterior myocardial infarction, when challenged by a new episode of acute ischemia, represent one of the groups at very high risk for sudden death. (2) If the

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Section: Arrhythmiasmentioning

confidence: 99%