摘要
目的 研究地尔硫、普罗帕酮和胺碘酮对短阵心房快速除极诱发的心房有效不应期(ERP)变化的影响。方法 6 9例室上性心动过速消融成功后的自愿者 ,被随机分为对照组、地尔硫组、普罗帕酮组和胺碘酮组。以 4 0 0ms起搏周长 (PCL)分别对高位右心房、低位右心房、希氏束周围等部位进行S1S2 程序刺激 ,另以 3个不同PCL(35 0、4 0 0和 4 5 0ms)对右心耳进行S1S2 程序刺激 ,应用双极记录法测定各组在基础状态、心房快速除极前、后心房ERP和ERP频率自适应性 (ERP RA)的变化 ,同时观察心房快速除极后程序刺激过程中意外诱发继发性心房颤动 (AF)的情况。结果 基础状态下 ,各组 4 0 0ms周长下心房各部位ERP差异不显著 ;心房快速除极前 ,对照组和地尔硫组心房各部位ERP无明显改变 ,而普罗帕酮组和胺碘酮组心房各部位ERP均明显延长 ;心房快速除极后 ,地尔硫组心房各部位ERP较除极前无明显缩短 ,对照组、普罗帕酮组和胺碘酮组心房各部位ERP较除极前均明显缩短。对照组、普罗帕酮组和胺碘酮组心房快速除极后斜率均值较除极前明显下降 ,地尔硫组心房快速除极后斜率均值较除极前无明显变化。地尔硫组、普罗帕酮组和胺碘酮组心房快速除极后继发AF发生阵数明显低于对照组。结论 预先给予地尔硫可以阻止心?
Objective To investigate the effect of antiarrhythmic drugs on the alteration of atrial effective refractory period (ERP) induced by short term rapid atrial depolarization.Methods Sixty nine volunteers with supraventricular tachycardia after successful radiofrequence catheter ablation were randomly divided into control group,diltiazem group,propafenone group and amiodarone group.Atrial ERP was measured with S 1S 2 programmed electrical stimulation at a pacing cycle length of 400 ms in multiple sites including the high right atrium (HRA),the low right atrium (LRA),and His bundle area (HB),and at 3 other different cycles length (350,400,450 ms)in the right atrial appendage (RAA) at baseline (after autonomic blockade),pre tachycardia(post drug) and post tachycardia in all subjects.The ERP adaptation to rate and its degree were established by evaluation of the slope values.The episodes of secondary atrial fibrillation (AF) caused by programmed stimulation were detected simultanously.Results The basic ERP in all stimulating sites of the right atrium was similar among all groups.The pre tachycardia ERP in all stimulating sites remained unchanged in control group and diltiazem group,and increased significantly in propafenone group and amiodarone group.The post tachycardia ERP in all stimulating sites decreased obviously in control group,propafenone group and amiodarone group except stable in diltiazem group,compared with pre tachycardia atrial ERP.The post tachycardia mean slope value decreased apparently in control group,propafenone group and amiodarnoe group ( P <0 01),and did not changed in diltiazem group ( P >0 05) as compared with pretachycardia one.The episodes of secondary AF decreased significantly in diltiazem group,propafenone and amiodarone group as compared with that in control group.Conclusions Pretreatment with diltiazem may prevent atrial acute electrical remodeling induced by rapid atrial depolarization,suggesting that calcium overload during rapid atrial depolarization may be at least partially responsible for electrical remodeling induced by rapid atrial depolarization.Diltiazem,propafenone and amiodarone can reduce episodes of secondary AF because diltiazem has an effect on preventing of ERP remodeling induced by short term rapid atrial depolarzation,and propafenone and amiodarone have effects on increase of the duration of ERP.
出处
《中华心律失常学杂志》
2003年第1期46-49,共4页
Chinese Journal of Cardiac Arrhythmias
