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Early autonomic and repolarization abnormalities contribute to lethal arrhythmias in chronic ischemic heart failure

Characteristics of a novel heart failure model in dogs with postmyocardial infarction left ventricular dysfunction

Philip B. Adamson, MD, FACC^a and Emilio Vanoli, MD^a

^a W.K. Warren Medical Research Institute, Departments of Physiology and Medicine/Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
Dipartimento di Cardiologia, Universita’ di Pavia, IRCCS Policlinico S. Matteo, Pavia, Italy

View larger version (27K): [in a new window]   Figure 1 Incidence of spontaneous ventricular arrhythmias in susceptible (A) and resistant (B) dogs as ischemic heart failure progressed over time (p = 0.001 susceptible vs. resistant SCD). Baseline arrhythmia incidence was when the left ventricular ejection fraction reached the target range (35%, see text). 0 = no arrhythmias; PVC = premature ventricular contraction; SCD = sudden cardiac death; VTns = nonsustained ventricular tachycardia (<20 beats); VTs = sustained ventricular tachycardia (>20 beats).

View larger version (21K): [in a new window]   Figure 2 An example of spontaneous arrhythmia progression over time in a susceptible (A) and resistant (B) dog with ischemic heart disease and moderate left ventricular dysfunction (EF approximately 35%). Note the rapid progression to sustained, incessant ventricular tachycardia in the susceptible dog within three months. In contrast, the resistant dog had isolated premature ventricular contractions after six months of follow-up. Left ventricular ejection fractions in the two dogs were similar. EF = ejection fraction; MI = myocardial infarction.

View larger version (24K): [in a new window]   Figure 3 Representative examples of QT intervals at different cycle lengths from one susceptible (A) and one resistant (B) dog 30 days after myocardial infarction (open circles) and after development of ischemic left ventricular dysfunction (open triangles). The normal QT and RR interval relationship is demonstrated from 10 normal dogs in the closed circles. Nonlinear regression analysis was used to produce the best-fit line to illustrate the normal QT to RR interval relationship. EF = ejection fraction; MI = myocardial infarction.