Mg. Angelos et al., Flow requirements in ventricular fibrillation: An in vivo nuclear magneticresonance analysis of the left ventricular high-energy phosphate pool, ANN EMERG M, 34(5), 1999, pp. 583-588
Study objective: We sought to determine whether flow rates of approximately
60% of normal Values are sufficient to preserve the left ventricular myoca
rdial high-energy phosphate pool during ventricular fibrillation (VF).
Methods: Mixed-breed swine (weight 22.4+/-2.5 kg) were anesthetized with al
pha-chloralose, placed in a slate of VF, and perfused with extracorporeal c
irculation at a target flow of 50 mL.kg(-1).min(-1). In vivo whole-wall (av
erage of left ventricular wall) and spatially localized phosphorous-31 nucl
ear magnetic resonance (NMR) spectra were acquired at baseline and during V
F.
Results: Mean flow during VF was 58+/-20 mL.kg(-1).min(-1) (+/-SD; 95% conf
idence interval, 44 to 71) or about 60% of baseline cardiac output (n=13).
Whole-wall adenosine triphosphate (ATP) decreased during perfused VF (P<.05
), whereas creatine phosphate (CP) remained unchanged from baseline. With s
patially localized NMR, the ratios of CP/ATP were similar at baseline in al
l layers (endocardium --> epicardium) of the left ventricular wall. However
, during perfused VF, subepicardial CP/ATP ratios increased by 14% to 40% c
ompared with baseline values, whereas subendocardial CP/ATP ratios remained
unchanged (1% to 3% increase). An additional 4 animals perfused at 72+/-10
mL.kg(-1).min(-1) (+/-SD; 95% confidence interval, 56 to 92) during VF had
preservation of CP and ATP levels.
Conclusion: Flow levels equivalent to 60% of baseline cardiac output were i
nsufficient to maintain normal high-energy phosphate levels in the in vivo
fibrillating myocardium. At this level of flow, myocardial high-energy phos
phate loss is nonhomogeneous within the left ventricular wall.