Failure of Antiarrhythmic Drugs to Prevent Experimental Reperfusion Ventricular Fibrillation
Failure of Antiarrhythmic Drugs to Prevent Experimental Reperfusion Ventricular Fibrillation
复制标题
抗心律失常药物无法预防实验性再灌注心室颤动
DOI：
10.1161/01.cir.63.1.70
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发表时间：
1981
期刊：
影响因子：
37.8
通讯作者：
L. Dreifus
中科院分区：
文献类型：
--
作者：
E. Michelson;J. Kmetzo;E. Kaplinsky;L. Dreifus
99只成年杂种狗接受了冠状动脉左前降支近端急性结扎。30分钟后，解除闭塞，评估五种抗心律失常方案在消除再灌注室颤方面的有效性。五个方案包括：方案1 -静脉注射利多卡因，结扎和预释放（n = 19）；方案2 -仅灌注前静脉注射利多卡因（n = 22）；方案3 -慢性，口服，每日胺碘酮，提前2周（n = 19）；方案4 -静脉注射普鲁卡因胺，预灌注（n = 21）；方案5 -静脉注射维拉帕米，预灌注（n = 18）。对存活至再灌注的犬的再灌注室颤发生率进行评估，并将结果与77只接受相同冠状动脉闭塞和释放程序的对照犬进行比较。再灌注心室颤动的发生率如下：方案1 - 15只狗中有7只（47%）；方案2 - 18例中6例（33%）；方案3:16只狗中有11只（69%）；方案4:17只狗中有8只（47%）；实验5 - 17只狗中有10只（59%），而对照组60只狗中有36只（60%）。卡方分析显示方案2是有益的（p < 0.05）。然后根据冠状动脉结扎前的心律失常事件将狗分为高风险和低风险亚组，并制定再灌注室颤发生的预测风险指标。Mantel-Haenszel统计分析方法显示，这些方案均未导致再灌注室颤发生率的统计学显著降低。因此，使用这些预测指标加上适当的统计方法，意外地揭示了一系列抗心律失常药物在预防再灌注室颤方面的功效的局限性。
SUMMARY Ninety-nine adult mongrel dogs underwent acute ligation of the proximal left anterior descending coronary artery. Thirty minutes later, the occlusion was released to evaluate the effectiveness of five antiarrhythmic protocols in eliminating reperfusion ventricular fibrillation. The five protocols included: protocol 1 — i.v. lidocaine, preligation and prerelease (n = 19); protocol 2 — i.v. lidocaine, prereperfusion only (n = 22); protocol 3 — chronic, oral, daily amiodarone for 2 weeks preligation (n = 19); protocol 4 — i.v. procainamide, preligation and prereperfusion (n = 21); and protocol 5 — i.v. verapamil, prereperfusion (n = 18). Each regimen was evaluated with respect to the incidence of reperfusion ventricular fibrillation in dogs that survived to reperfusion, and the results were compared to 77 control dogs that underwent identical coronary artery occlusion and release procedures without drug therapy. The incidence of reperfusion ventricular fibrillation was as follows: protocol I - seven of 15 dogs (47%); protocol 2 — six of 18 (33%); protocol 3 — 11 of 16 dogs (69%); protocol 4 — eight of 17 dogs (47%); and protocol 5 — 10 of 17 dogs (59%), compared with 36 of 60 (60%) in control dogs. Using chi-square analysis, protocol 2 was beneficial (p < 0.05). The dogs were then stratified into high- and low-risk subgroups based on the arrhythmic events of the antecedent coronary artery ligation periods, and predictive risk indexes for the occurrence of reperfusion ventricular fibrillation were developed. The Mantel-Haenszel method of statistical analysis revealed that none of these protocols resulted in a statistically significant reduction in the incidence of reperfusion ventricular fibrillation. Thus, use of these predictive indexes plus appropriate statistical methods has revealed, unexpectedly, limitations in the efficacy of a spectrum of antiarrhythmic agents in preventing reperfusion ventricular fibrillation.