Evaluation of Proarrhythmic Effect of Antiarrhythmic Drugs on Ventricular Tachycardia Associated with Congestive Heart Failure : CURRENT THERAPY OF INTRACTABLE HEART FAILURE
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概要
- 論文の詳細を見る
The usefulness and limitations of antiarrhythmic drugs in ventricular tachycardias (VT) associated with congestive heart failure remain uncertain. The purpose of this study is to evaluate the proarrhythmic effects of antiarrhythmic drugs in patients with refractory VT associated with left ventricular dysfunction using electrophysiologic study (EPS). Twenty-four patients with left ventricular dysfunction, defined by left ventricular ejection fraction (LVEF) lower than 40% using left ventriculography, were studied. The average LVEF was 29.5%. As for underlying heart disease, 14 had old myocardial infarction, 8 cases had dilated cardiomyopathy and 2 had aortic regurgitation. As a control to this group, 23 cases with underlying heart disease and LVEF higher than 40%, and 27 cases with no obvious heart disease were studied. We considered a drug to have proarrhythmic effects if 1) it de-creased by one the number of stimuli needed to induce VT, 2) induced non-sustained VT in the control study which changed to induced sustained VT, 3) the sustained VT or ventricular fibrillation was newly induced, or 4) the induced sustained VT which was stopped by pacing in the control study changed to induced VT which could not be terminated by pacing and required DC shock. Proarrhythmic effects were recognized in 17 of 24 cases with left ventricular dysfunction. Of the 67 drug trials, proarrythmic effects were seen in 26. Proarrhythmias were observed in 9 of 23 cases (39.1%) with organic heart disease associated with LVEF higher than 40%. In 12 of 69 drug trials (17.4%) proarrhythmias were observed. Of 27 cases with no obvious heart disease 10 cases (37%) had proarrhythmias. In 14 of 130 drug trials (10.8%), proarrhythmias were recognized. In conclusion, the incidence of ventricular arrhythmias on EPS in cases with low LVEF was 70.8%, and 33.8% in drug trial, higher than in cases with organic heart disease and LVEF higher than 40%. Although the relation to spontaneous occurrence is not always clear, the effects of antiarrhythmic drugs therapy on ventricular arrhythmias in patients with congestive heart failure needs careful consideration and should be an interesting topic for future research.
- 社団法人日本循環器学会の論文
- 1992-01-20
著者
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Kasanuki Hiroshi
Department of Cardiology, Tokyo Women's Medical University
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Shoda Morio
Department of Cardiology, Tokyo Women's Medical University
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Hosoda Saichi
Department Of Cardiology The Heart Institute Of Japan Tokyo Women's Medical College
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Nirei Takashi
Department of Cardiology, Tokyo Metropolitan Health and Medical Treatment Corporation Ebara Hospital
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Nirei Takashi
Department Of Cardiology Osaka City General Hospital
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Shoda Morio
Department Of Cardiology Tokyo Women's Medical University
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Nirei Takashi
Tokyo Women's Medical College
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Ohnishi Satoshi
Department Of Cardiology Tokyo Women's Medical University
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Onishi Satoshi
The Heart Institute Tokyo Women's Medical College
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Shoda Morio
Department Of Cardiology The Cardiovascular Center Of Sendai
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Tanaka Naohide
HIJC Investigators
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Onishi Satoshi
Department Of Cardiology Tokyo Women's Medical University
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Nirei Takashi
Division Of Cardiology The Heart Institute Of Japan Tokyo Women's Medical College Tokyo Japan
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Ohnishi Satoshi
Department Of Cardiology Kanto Medical Center Ntt Ec
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Onishi Satoshi
Department Of Internal Medicine Heart Institute Of Japan Tokyo Women's Medical College
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Kasanuki Hiroshi
Department Of Cardiology The Heart Institute Of Japan
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Hosada Saichi
Department Of Cardiology Sakakibara Heart Institute
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Hosoda Saichi
Department Of Cardiology And Internal Medicine
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Hosoda Saichi
Department Of Cardioangiology And Internal Medicine Jichi Medical School
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Hosoda Saichi
Tokyo Womnen's Med. Coll. Heart Iustilute Japan
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Ohnishi Satoshi
Department of Applied Chemistry, Faculty of Engineering, Yamagata University
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