Takase B, Uehata A, Nishioka T, Arakawa K, Satomura K, Ohsuzu F, Kurita A
Self Defense Force Central Hospital, Internal Medicine, Tokyo, Japan.
Clin Cardiol. 1999 Feb;22(2):107-12. doi: 10.1002/clc.4960220210.
Decreased heart rate variability indices (HRV) are associated with untoward outcome of patients with ischemic heart disease (IHD). Most class I antiarrhythmic agents decrease HRV, but aprindine (a new class I antiarrhythmic agent) is reported to increase HRV in patients without ischemia.
The study was undertaken to determine whether apridine might increase HRV in patients with IHD.
To investigate the effect of aprindine on HRV in patients with IHD, we performed 24-h ambulatory electrocardiogram (ECG) at the end of placebo and aprindine (60 mg daily) treatment phases on 38 patients with IHD and at least isolated premature ventricular contractions (PVC). The study protocol utilized a single blind, 4-week, placebo-controlled design. Heart rate variability from ambulatory ECG included SDNN (ms), SDANN (ms), SD (ms), rMSSD (ms), pNN50 (%); frequency analysis of HRV consisting of total (ms, 0.01-1.00 Hz), low (ms, 0.04-0.15 Hz), and high (ms, 0.15-0.40 Hz) components.
Study patients were divided into three groups according to the severity of IHD and antiarrhythmic efficacy of aprindine. Group 1 consisted of 15 patients with angina with single-vessel disease, and Group 2 was composed of 10 patients with either multivessel disease or post myocardial infarction; PVCs decreased in both groups as result of aprindine treatment. Group 3 consisted of 13 patients who showed no decreased PVC after aprindine treatment. RMSSD increased, and pNN50 and high-frequency spectra tended to increase in Group 1, while SD, rMSSD, pNN50, and total and low-frequency spectra decreased in Group 3; no significant changes were observed in Group 2. Aprindine significantly augments vagal activity, as reflected by the increase of rMSSD, pNN50, and high-frequency spectra in mild IHD.
These salutary effects are less in more severe IHD, but aprindine does not aggravate HRV. Thus, if there are salutary effects on arrhythmias and no proarrhythmic effects, aprindine could be prescribed to patients with IHD without concern about decreasing HRV.
心率变异性指标（HRV）降低与缺血性心脏病（IHD）患者的不良预后相关。大多数I类抗心律失常药物会降低HRV，但据报道，阿普林定（一种新型I类抗心律失常药物）可增加无缺血患者的HRV。
本研究旨在确定阿普林定是否能增加IHD患者的HRV。
为研究阿普林定对IHD患者HRV的影响，我们对38例IHD且至少有孤立性室性早搏（PVC）的患者，在安慰剂和阿普林定（每日60mg）治疗阶段结束时进行了24小时动态心电图（ECG）检查。研究方案采用单盲、4周、安慰剂对照设计。动态心电图的心率变异性包括标准差（SDNN，ms）、平均标准差（SDANN，ms）、标准差（SD，ms）、相邻RR间期差值的均方根（rMSSD，ms）、差值大于50ms的相邻RR间期占总RR间期的百分比（pNN50，%）；HRV的频率分析包括总功率（ms，0.01 - 1.00Hz）、低频功率（ms，0.04 - 0.15Hz）和高频功率（ms，0.15 - 0.40Hz）成分。
根据IHD的严重程度和阿普林定的抗心律失常疗效，研究患者分为三组。第1组由15例单支血管病变的心绞痛患者组成，第2组由10例多支血管病变或心肌梗死后患者组成；阿普林定治疗后两组的PVC均减少。第3组由13例阿普林定治疗后PVC未减少的患者组成。第1组的rMSSD增加，pNN50和高频谱趋于增加，而第3组的SD、rMSSD、pNN50以及总功率和低频谱降低；第2组未观察到显著变化。阿普林定显著增强迷走神经活动，轻度IHD中rMSSD、pNN50和高频谱的增加反映了这一点。
在更严重的IHD中这些有益作用较小，但阿普林定不会加重HRV。因此，如果对心律失常有有益作用且无促心律失常作用，可给IHD患者开具阿普林定，而无需担心降低HRV。
