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題名 | Effects of Verapamil and Procainamide on Acute Atrial Electrical Remodeling Induced by Short-Term Rapid Atrial Pacing in Humans=Verapamil及Procainamide對於人體心房組織短期快速電刺激所誘發的電氣重塑效應之影響 |
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作者 | 朱志生; 李坤泰; 鄭凱鴻; 林宗憲; 李明義; 溫文才; 許勝雄; 賴文德; | 書刊名 | The Kaohsiung Journal of Medical Sciences |
卷期 | 23:12 2007.12[民96.12] |
頁次 | 頁599-610 |
分類號 | 418.225 |
關鍵詞 | 抗心律不整藥物; 有效不反應期; 電氣重塑; 快速心房刺激; Antiarrhythmic agents; Effective refractory period; Electrical remodeling; Rapid atrial pacing; |
語文 | 英文(English) |
中文摘要 | 過去文獻報導指出,不管是自發性或是電刺激所引發的心房顫動之後,都可以發現在人體有急性電氣重塑的效應。本研究欲探討是否單純只利用 5 分鐘快速電刺激的方式,也能誘發電氣重塑效應,以及抗心律不整藥物 verapamil 及 procainamide 對於此效應之影響。總共有 20 位控制組患者於電氣生理學檢查中,接受從右心房高側位、速度每分鐘 150 下的快速電刺激五分鐘前後,測定其心房組織五個不同解剖位置 (包括右心房高側位,近端、中端與遠端冠狀靜脈竇,以及心房中隔) 之有效不反應期 (分別以 400 毫秒與 600 毫秒之週期長度取得 ; 有效不反應期 400 與有效不反應期 600)。電刺激後所引起的有效不反應期縮短程度定義為急性心房電氣重塑效應。利用相同的研究架構,另外分別有 15 位受試者於當中接受靜脈 verapamil (0.15 毫克/公斤) 及 15 位受試者於當中接受靜脈 procainamide (15 毫克/公斤) 來評估藥物影響。研究結果顯示沒有藥物的控制組,急性心房電氣重塑效應可以在各個不同心房組織位置顯著地表現出來 (所有 p 值 < 0.001)。平均有效不反應期 400 與有效不反應期 600 的縮短程度分別為 9 +/- 4% 與 8 +/- 4%。在接受靜脈注射藥物後,procainamide 可以顯著延長有效不反應期 400 與有效不反應期 600 (p 值 < 0.01) 的基礎值,但是 verapamil 則沒有顯著影響。而急性心房電氣重塑效應,即使在接受完 procainamide 或是 verapamil 仍然可以在各個不同心房組織位置顯著的表現出來 (所有 p 值 < 0.001)。本研究結論為,在人體急性心房重塑效應,即使只利用五分鐘快速電刺激的方式,就可以誘發出來。靜脈注射 procainamide 或是 verapamil 都無法阻斷這急性心房重塑效應的表現。 |
英文摘要 | Atrial electrical remodeling (ER) after spontaneous or pacing-induced atrial fibrillation has been previously described in humans. We investigated atrial ER induced by a 5-minute period of rapid atrial pacing and the pharmacologic effects of verapamil and procainamide on this atrial ER phenomenon. The atrial effective refractory periods (ERPs) at drive cycle lengths of 400 (ERP400) and 600 (ERP600) ms, at five representative atrial sites (high right atrium [HRA]; proximal, middle and distal coronary sinus; interatrial septum), were determined in 20 patients at baseline and immediately after cessation of a 5-minute period of rapid pacing from the HRA at a rate of 150 bpm. The degrees of atrial ERP400 and ERP600 shortening after pacing were calculated as acute atrial ER. The same protocol was repeated in another 15 patients after intravenous administration of verapamil (0.15 mg/kg) and in another 15 patients after intravenous administration of procainamide (15 mg/kg). The results demonstrated that, in the control state acute atrial ER can be significantly demonstrated at each atrial representative site (p < 0.001). The mean ERP400 and ERP600 shortenings were 9 +/- 4% and 8 +/- 4%, respectively. After procainamide infusion, but not after verapamil, baseline ERP400 and ERP600 values were significantly prolonged at the five representative atrial sites (p < 0.01). Acute atrial ER could still be demonstrated at each atrial site after procainamide or verapamil infusion (p < 0.001). In conclusion, acute atrial ER can be demonstrated after only a 5-minute period of rapid atrial pacing in humans. Intravenous verapamil or procainamide does not abolish this ER process. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。