De Ferrari G M, Vanoli E, Curcuruto P, Tommasini G, Schwartz P J
Centro di Fisiologia Clinica e Ipertensione, University of Milan, Italy.
Am Heart J. 1992 Oct;124(4):883-90. doi: 10.1016/0002-8703(92)90968-2.
The potential antiarrhythmic efficacy of pharmacologic parasympathetic activation is still controversial. This study assessed the antiarrhythmic effect of saline solution (n = 9) and of the muscarinic agonist oxotremorine (1.5 micrograms/kg administered intravenously) (n = 17) in a feline animal model in which malignant arrhythmias were reproducibly elicited by the combination of acute myocardial ischemia and left stellate ganglion stimulation. Although saline solution had no effect, oxotremorine significantly decreased heart rate, blood pressure, the incidence of ventricular fibrillation from 47% to 0% (p = 0.004), and the incidence of malignant arrhythmias (either ventricular tachycardia or ventricular fibrillation) from 88% to 12% (p less than 0.001). When reduction in heart rate was prevented by means of atrial pacing (n = 15), the incidence of malignant arrhythmias was still significantly reduced from 87% to 27% (p = 0.001). Arrhythmias were also graded as follows: 0 = no premature ventricular contractions; 1 = 1 to 10 premature ventricular contractions; 2 = 11 to 50 premature ventricular contractions; 3 = ventricular tachycardia; 4 = ventricular fibrillation. Arrhythmia severity was 3.29 +/- 0.16 (SEM) in the control trials and was reduced to 0.76 +/- 0.26 (p less than 0.001) by oxotremorine and to 1.53 +/- 0.34 by oxotremorine and pacing (p = 0.002). Therefore a muscarinic agonist can significantly reduce malignant arrhythmias during acute myocardial ischemia and may represent a novel approach to the prevention of sudden cardiac death.
药理学上的副交感神经激活的潜在抗心律失常疗效仍存在争议。本研究在猫动物模型中评估了生理盐水（n = 9）和毒蕈碱激动剂氧化震颤素（静脉注射1.5微克/千克）（n = 17）的抗心律失常作用，在该模型中，急性心肌缺血和左星状神经节刺激联合可重复性地诱发恶性心律失常。尽管生理盐水没有效果，但氧化震颤素显著降低了心率、血压，室颤发生率从47%降至0%（p = 0.004），恶性心律失常（室性心动过速或室颤）发生率从88%降至12%（p < 0.001）。当通过心房起搏防止心率降低时（n = 15），恶性心律失常发生率仍显著从87%降至27%（p = 0.001）。心律失常还分级如下：0 = 无室性早搏；1 = 1至10次室性早搏；2 = 11至50次室性早搏；3 = 室性心动过速；4 = 室颤。对照试验中心律失常严重程度为3.29±0.16（SEM），氧化震颤素使其降至0.76±0.26（p < 0.001），氧化震颤素加起搏使其降至1.53±0.34（p = 0.002）。因此，毒蕈碱激动剂可显著降低急性心肌缺血期间的恶性心律失常，可能代表预防心脏性猝死的一种新方法。
