Jones D L, Klein G J, Guiraudon G M, Yee R, Brown J E, Sharma A D
Department of Medicine, University of Western Ontario, University Hospital, London, Canada.
J Electrocardiol. 1991 Oct;24(4):299-305. doi: 10.1016/0022-0736(91)90012-b.
Patients with automatic defibrillators frequently require chronic antiarrhythmic drug therapy or receive acute therapy with the onset of symptoms. The effects on energy requirements for defibrillation of lidocaine hydrochloride and verapamil hydrochloride, two commonly used antiarrhythmic agents, were examined in 20 successive patients undergoing corrective arrhythmia surgery. The minimum energy requirement for ventricular defibrillation before and 5 minutes after the administration of 150 mg of lidocaine intravenously (n = 8), or 10 minutes after 10 mg of verapamil intravenously (n = 12), were determined. Each patient was assigned to receive either verapamil or lidocaine. Three mesh coil defibrillating electrodes (Medtronic 6891, 6892) were sutured to the epicardium of the right and left ventricles. Ventricular fibrillation was induced using alternating current. After a minimum of 10 seconds of fibrillation, the minimum energy for defibrillation was established using sequential pulse defibrillation. The preselected drug was then infused and the ventricular defibrillation energy was again determined after 5 or 10 minutes circulation time. Lidocaine did not alter the minimum energy for defibrillation (3.0 +/- 1.4 J vs. 3.0 +/- 1.8 J, mean +/- SD), despite plasma levels of lidocaine that averaged 13.2 +/- 1.9 mumol/l. In contrast, verapamil significantly increased (3.9 +/- 2.2 J vs. 6.5 +/- 2.9 J) the minimum energy necessary for defibrillation. The difference in defibrillation energy was significantly correlated to the fall in systolic blood pressure induced by verapamil administration (r = 0.72). These data reinforce the necessity for determining efficacy of defibrillation when medication changes are instituted. Verapamil should be used with caution in patients with automatic defibrillators and marginal defibrillation threshold.
植入自动除颤器的患者常常需要长期抗心律失常药物治疗，或在症状发作时接受急性治疗。我们对20例接受心律失常矫正手术的连续患者进行了研究，以考察两种常用抗心律失常药物盐酸利多卡因和盐酸维拉帕米对除颤所需能量的影响。分别测定了静脉注射150mg利多卡因后5分钟（n = 8），或静脉注射10mg维拉帕米后10分钟（n = 12），以及用药前心室除颤所需的最低能量。每位患者被分配接受维拉帕米或利多卡因治疗。将三个网状线圈除颤电极（美敦力6891、6892）缝合至左右心室的心外膜。使用交流电诱发心室颤动。在至少10秒的颤动后，采用序贯脉冲除颤确定除颤所需的最低能量。然后输注预先选定的药物，并在5或10分钟循环时间后再次测定心室除颤能量。尽管利多卡因血浆水平平均为13.2±1.9μmol/l，但利多卡因并未改变除颤所需的最低能量（3.0±1.4J对3.0±1.8J，均值±标准差）。相比之下，维拉帕米显著增加了除颤所需的最低能量（3.9±2.2J对6.5±2.9J）。除颤能量的差异与维拉帕米给药引起的收缩压下降显著相关（r = 0.72）。这些数据强化了在改变用药时确定除颤效果的必要性。对于植入自动除颤器且除颤阈值临界的患者，应谨慎使用维拉帕米。
