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Effects of the sympathetic nervous system on conduction and refractoriness in normal and ischemic myocardium

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Myocardial Ischemia and Arrhythmia

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Summary

In the normal ventricle conduction velocity is hardly influenced by sympathetic stimulation, whereas refractory periods shorten. The projection of sympathetic nerves to the ventricles is inhomogeneous and variable between individuals of the same species. Therefore, the effects of sympathetic stimulation on electrophysiological parameters are inhomogeneous as well. This inhomogeneity of effects may add up to or mitigate basic dispersion. It is not known whether electrical instability caused by sympathetic stimulation in the normal heart can be large enough to initiate life-threatening arrhythmias.

During acute ischemia there are almost immediate changes in extracellular K+ concentration. Conduction velocity starts to decrease after 2 to 3 min of ischemia; refractory periods increase even earlier. Both factors increase the chances for reentrant arrhythmias. Dispersion in refractory periods develops over the ischemic border between the normal and ischemic myocardium, but also within the central ischemic area. This was assessed with measurement of local fibrillation intervals, because refractory periods cannot be measured at more than one site at a time. Dynamic conditions such as acute ischemia or sympathetic stimulation require multiple simultaneous measurements, because parameters — for instance, diastolic threshold for excitation — change continuously.

Sympathetic stimulation increases conduction velocity during acute ischemia. In itself, this would be an anti-arrhythmogenic factor. Local fibrillation intervals are prolonged by sympathetic stimulation, whereas they are shortened in the normal heart. This indicates that sympathetic stimulation provokes opposite effects on refractoriness in normal and ischemic myocardium. Such an effect would increase the propensity to reentrant arrhythmias, especially during mild ischemia.

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Authors and Affiliations

  1. Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, and The Interuniversity Cardiology Institute, The Netherlands

    M. J. Janse

  2. Department of Experimental Cardiology, AMC, Meibergdreef 9, NL-1105 AZ, Amsterdam Zuidoost, Netherlands

    Dr. T. Opthof

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    M. Zehender  & H. Just  & 

  2. Innere Medizin, Universitätskrankenhaus Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    T. Meinertz

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Opthof, T., Janse, M.J. (1994). Effects of the sympathetic nervous system on conduction and refractoriness in normal and ischemic myocardium. In: Zehender, M., Meinertz, T., Just, H. (eds) Myocardial Ischemia and Arrhythmia. Steinkopff. https://doi.org/10.1007/978-3-642-72505-0_8

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