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(Chest. 2000;117:1118-1123.)
© 2000 American College of Chest Physicians

Atrial Function During Cardiac Arrest Caused by Ventricular Fibrillation*

Andrej Pernat, MD; Max Harry Weil, MD, PhD, Master FCCP; Shijie Sun, MD; Wanchun Tang, MD, FCCP; Hitoshi Yamaguchi, MD and Joe Bisera, MSEE

* From the Institute of Critical Care Medicine (Drs. Pernat, Weil, Sun, Tang, and Yamaguchi, and Mr. Bisera), Palm Springs, CA; and The University of Southern California School of Medicine (Drs. Weil, Sun, and Tang, and Mr. Bisera), Los Angeles, CA.

Address correspondence to: Max Harry Weil, MD, PhD, Master FCCP, Institute of Critical Care Medicine, 1695 North Sunrise Way, Bldg #3, Palm Springs, CA 92262-5309; e-mail: Weilm{at}aol.com

Objectives: To report observations on preserved regular atrial electrical and mechanical systole during ventricular fibrillation (VF) and to quantitate blood flow generated by atrial contractions in this setting.

Methods: In 10 rats, right atrial pressure pulses were continuously recorded before and for an interval of 8 min after inducing VF. In 3 isolated, perfused rat hearts, epicardial right atrial electrograms were recorded after inducing VF. In 15 pigs, transesophageal echo-Doppler measurements were obtained with pulsed and color-Doppler visualization of flow across the mitral valve after onset of VF.

Results: In each rat, regular right atrial pressure pulses were documented during VF. These persisted over an average interval of 7.5 min. In isolated, perfused hearts, right atrial contractions were accompanied by regular atrial depolarizations. In pigs, regular atrial contractions generated atrial stroke volumes of approximately 12 mL, or 25% of prearrest values during the first minute after onset of VF, but those declined to approximately 6 mL after 10 min of untreated cardiac arrest. Blood flow from the left atrium into the left ventricle failed to advance significantly into the systemic circuit. During atrial diastole, we observed reversal of flow into the left atrium.

Conclusions: Atrial contractions are preserved during the initial 8 min or more after cardiac arrest due to VF. Substantial forward flow into the left ventricle failed to advance through the outflow tract but regurgitated into the atrium during atrial diastole.

Key Words: atrial pressure • cardiac arrest • resuscitation • transesophageal echo-Doppler • ventricular fibrillation






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