Ventricular Fibrillation and Sudden Coronary Death

The publication embodied here represents the life work of a premier Russian scientist studying Sudden Cardiac Death. As one can gather from more than 35 first authored publications cited in the References, Dr. Rajskina has been involved with the investigation of mechanisms responsible for Sudden Cardiac Death for over 30 years. She has brought a classical approach to the sub ject, considering the effects of blood supply disturbances, electrophysiological changes that occur after regional ischemia, metabolic alterations, and the role of the autonomic nervous system in modulating these changes. These studies naturally lead to a consideration of interventions, based on her research, to prevent ventricular fibrillation after coronary artery occlusion. This is a wide ranging treatise indicative of a lifetime of study of the problem and filled with the richness of scientific experiments generated in its pursuit. There is so much in here that will be of interest to the arrhythmologist interested in Sudden Cardiac Death, whether this is on a single channel level, in vitro study of hearts, in vivo investigation of intact animals, or at the bedside. And throughout it all, statements are copiously documented with more than 850 references. That alone is worth hours of computer searching. I am very proud to have been asked by this outstanding scientist to write a brief Preface to her monumental contribution. All of us involved in the study of arrhythmic mechanisms responsible for Sudden Cardiac Death can hold Dr.

1. The Ventricular Fibrillation and Heart's Blood Supply.- 1.1 The types of cardiac blood supply.- 1.2 Hemodynamic changes.- 1.3 Collateral blood supply of the heart.- 1.4 The size of the ischemie zone.- 1.5 Po2 in the ischemie zone.- 1.6 Conclusion.- 2. Ventricular Fibrillation and Electrophysiological Changes.- 2.1 Role of the VPB in the onset of VF after CAO.- 2.2 Role of ionic current, membrane potentials, automatism, excitability, and conductivity changes in the appearance of VF after CAO.- 2.3 Study of mechanisms of ventricular arrhythmia using mathematical modeling and computer simulation.- 2.4 Conclusions.- 3. Ventricular Fibrillation and Changes in Metabolism of the Heart after Local Ischemia.- 3.1 Ischemic changes in the ox-red equilibrium.- 3.2 Ischemic disturbances in acid-base equilibrium.- 3.3 Ischemic disturbances in ion equilibrium.- 3.4 Conclusion.- 4. Role of the Sympathoadrenal System in the Appearance of Ventricular Fibrillation after Coronary Artery Occlusion.- 4.1 Afferent cardiac nerve activity and ventricular fibrillation after coronary artery occlusion.- 4.2 Afferent activity of the aortal nerve after CAO.- 4.3 Catecholamine balance in the heart and ventricular fibrillation after coronary artery occlusion.- 4.4 Conclusions.- 5. Role of Adrenaline in the Mechanisms of Ventricular Fibrillation Onset after Occlusion of Coronary Artery.- 5.1 Effect of adrenaline on the ox-red equilibrium of the heart.- 5.2 Effect of adrenaline on the acid-base equilibrium.- 5.3 Effect of adrenaline on ionic equilibrium.- 5.4 Influence of adrenaline on the heart's electrophysiological processes.- 5.5 The comparison of the effects of arrhythmic and non- arrhythmic doses of adrenaline on a metabolism.- 5.6 Comparison of the effects of coronary artery occlusion andadrenaline on metabolism and electrophysiological processes in the heart.- 6. The Prevention of Ventricular Fibrillation after Coronary Artery Occlusion.- 6.1 The main directions of the antifibrillatory influences.- 6.2 Method of computer control of the use of antifibrillatory substances.- 6.3 The methods of prognostication of ventricular fibrillation.- 6.4 Evaluation of effectiveness of antifibrillatory influences.- 6.5 Conclusions.- 7. Mechanism of Ventricular Fibrillation Onset After Coronary Artery Occlusion.- 7.1 Electrophysiological hypotheses of ventricular fibrillation mechanism.- 7.2 Metabolic hypotheses of ventricular fibrillation.- 7.3 Neurohumoral hypotheses of ventricular fibrillation.- 7.4 Author's hypothesis based on the systemic approach to study of ventricular fibrillation mechanisms.- 7.5 Ventricular fibrillation as a result of adrenal overcompensation.- Implications.- References.