Flecainide: electrophysiologic and antiarrhythmic properties in refractory ventricular tachycardia.
Flecainide: electrophysiologic and antiarrhythmic properties in refractory ventricular tachycardia.
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氟卡尼：难治性室性心动过速的电生理和抗心律失常特性。
DOI：
10.1016/0002-9149(85)90726-x
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发表时间：
1985
期刊：
影响因子：
--
通讯作者：
Reid,PR
中科院分区：
文献类型：
--
作者：
Platia,EV;Estes,M;Heine,DL;Griffith,LS;Garan,H;Ruskin,JN;Reid,PR
22例患有冠状动脉疾病和自发性室性心动过速（VT）或室颤（VF）的患者在氟卡尼治疗前后（平均剂量418 ± 87 mg [平均值±标准差]）进行了心内电生理评价，并在可能时进行了动态监测。在开始氟卡尼治疗前，平均使用了4种抗癫痫药物，但均未成功。16例患者在64 ± 16小时的对照霍尔特监测中，均出现1次或多次VT，以及室性早搏复合波（VPC）。在控制期间的程控刺激诱发VT的22例患者中有17例。氟卡尼治疗后，霍尔特监测显示除1例患者外，所有患者的所有形式的VT均消除，成对VPC显著减少95%（p < 0.03），单个VPC显著减少70%（p < 0.005）。氟卡尼治疗期间的电生理研究显示AH、HV、PR、QRS和QTc间期以及心室有效不应期显著增加。17名服用氟卡尼的患者接受了程控刺激，平均血浆水平为1，075 ± 521 ng/ml，仅2名患者消融了诱导性室性心动过速，5名患者恶化，10名患者继续诱导室性心动过速。需要停药的不良反应不常见，在接受较高药物水平的患者中发生：1例充血性心力衰竭患者和1例重度窦性心动过缓患者。因此，虽然氟卡尼抑制霍尔特记录的复杂室性心律失常，但它很少改变对程控刺激的反应。在确定氟卡尼程控刺激治疗的预测值之前，建议谨慎用于复发性持续性VT或VF以及解释电生理学研究。
Twenty-two patients with coronary artery disease and spontaneous ventricular tachycardia (VT) or ventricular fibrillation (VF) underwent intracardiac electrophysiologic evaluation and, when possible, ambulatory monitoring before and after therapy with flecainide (mean dose 418 ± 87 mg [mean ±standard deviation]). An average of 4 antiarrhythmic agents were used and were unsuccessful before therapy with flecainide was begun. During 64 ± 16 hours of control Holter monitoring in 16 patients, all had 1 or more salvos of VT, as well as ventricular premature complexes (VPCs). Programmed stimulation during the control period induced VT in 17 of 22 patients. After flecainide therapy, Holter monitoring showed elimination of all forms of VT in all but 1 patient, as well as significant reduction of paired VPCs by 95% (p < 0.03) and single VPCs by 70% (p < 0.005). Electrophysiologic study during flecainide therapy showed significant increases in AH, HV, PR, QRS and QTc intervals, and the ventricular effective refractory period. Programmed stimulation in 17 patients taking flecainide, with a mean plasma level of 1,075 ± 521 ng/ml, showed ablation of inducible VT in only 2 patients, a worsening in 5 and continued VT inducibility in 10. Adverse effects that required drug withdrawal were infrequent and encountered in patients who received higher drug levels: 1 patient with congestive heart failure and 1 with severe sinus bradycardia. Thus, although flecainide suppresses complex ventricular arrhythmias on Holter recordings, it rarely alters the response to programmed stimulation. Caution is recommended in its use for recurrent sustained VT or VF and in the interpretation of electrophysiologic studies until the predictive value of programmed stimulation with flecainide therapy is established.