Effects of flecainide on ventricular function: clinical and experimental correlations.
Effects of flecainide on ventricular function: clinical and experimental correlations.
复制标题
氟卡尼对心室功能的影响：临床和实验相关性。
DOI：
10.1016/0002-9149(84)90510-1
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发表时间：
1984
期刊：
影响因子：
--
通讯作者：
B. Singh
中科院分区：
文献类型：
--
作者：
M. Josephson;N. Ikeda;B. Singh
氟卡胺具有特殊的电生理特性，对室性快速性心律失常有很高的抑制力。人们对其变力和血流动力学作用知之甚少。在离体兔乳头肌上，氟卡胺呈浓度依赖性地抑制乳头肌的收缩，阈值浓度为1.0μg/ml，静脉注射氟卡胺1 mg/kg和2 mg/kg时，心率和平均动脉压无明显变化。静脉注射的车辆。氟卡胺混悬剂对6例受试者无明显影响。无论左心室射血分数的水平如何，两种剂量都能产生类似的血流动力学效果。给药1 mg/kg后，右房平均压增加12%(p<；0.05)，2 mg/kg后增加15%(p<；0.01)。平均楔压增加44%(p<；0.05)和33%(p<；0.05)，平均肺动脉压增加27%(p<；0.01)和28%(p<；0.05)，体循环阻力增加10%(p<；0.05)和9%(P<；0.05)，肺血管阻力增加6%(p<；0.05)和49%(p<；0.05)。心脏指数(8%和12%，p<；0.05)、每搏输出量指数(11%和15%，p<；0.01)、每搏做功指数(12%，p<；0.05和21%，p<；0.01)以及左心室射血分数(15%和16%，p<；0.01)均显著降低。在373例(67例有心力衰竭病史)接受剂量氟卡胺控制室性快速性心律失常的患者中，有16例发生或加重了心力衰竭，发生率为4.3%。总体数据表明，氟卡胺表现出显著但温和的负性肌力作用，这种负性肌力作用可能在心功能受损的患者亚组中变得有临床意义。它在严重心肌功能低落的患者中的使用值得谨慎。
Flecainide has unusual electrophysiologic properties and a high potency for the suppression of ventricular tachyarrhythmias. Little is known about its inotropic and hemodynamic actions. In isolated rabbit papillary muscle, it produced a concentration-dependent depression of contractile force, the threshold concentration being 1.0 μg/ml. In patients undergoing coronary angiography for ischemic heart disease and given 1 (n = 11) and 2 mg/kg (n = 11) of flecainide acetate i.v., there was no change in heart rate or mean arterial pressure. The vehicle in which i.v. flecainide was suspended had no significant effects in 6 patients in whom it was tested. Both doses produced comparable hemodynamic effects irrespective of the level of the left ventricular ejection fraction. The mean right atrial pressure increased by 12% (p < 0.05) after 1 mg/kg and by 15% (p < 0.01) after 2 mg/kg of the drug. The corresponding increases in mean wedge pressure were 44% (p < 0.05) and 33% (p < 0.05), in mean pulmonary artery pressure 27% (p < 0.01) and 28% (p < 0.05), in systemic vascular resistance 10% (p < 0.05) and 9% (not significant [NS]) and in pulmonary vascular resistance 6% (NS) and 49% (p < 0.05). Significant decreases in cardiac index (8 and 12%, p < 0.05), stroke volume index (11 and 15%, p < 0.01) and stroke work index (12%, p < 0.05, and 21%, p < 0.01) as well as in left ventricular ejection fraction (15 and 16%, p < 0.01) were also induced by the 2 doses of flecainide. In 373 patients (67 with a history of cardiac failure) given doses of flecainide to control ventricular tachyarrhythmias, heart failure developed or was aggravated in 16, an incidence of 4.3%. The overall data indicate that flecainide exhibits significant but modest negative inotropic effects that may become clinically significant in the subset of patients with compromised ventricular function. Its use in patients with severely depressed myocardial function warrants caution.