Dolla E, Levy S, Cointe R, Moyal C, Bru P, Rossi P, Gérard R
Service de cardiologie, centre hospitalier universitaire Nord, Marseille.
Arch Mal Coeur Vaiss. 1991 Jul;84(7):917-21.
The effects of oral propranolol were studied in 24 patients with the WPW syndrome. The average daily dose of propranolol was 130 +/- 24 mg administered in 3 doses over a period of 48 to 72 hours. Endocavitary electrophysiological study was performed 2 to 4 hours after the last dose. The effective anterograde refractory periods (EARP) of the accessory and normal pathways were measured before and after propranolol (and, in both studies, before and after isoproterenol). The EARP of the accessory pathway was not affected by the propranolol. However, in the 9 patients in whom its value was less than 270 ms, it increased significantly (p = 0.01). The EARP of the accessory pathway measured after administration of isoproterenol increased significantly in all patients with oral propranolol (p = 0.001). Sustained reciprocating tachycardia could be induced in 19 patients and non-sustained reciprocating tachycardia in 5 other patients during base line electrophysiological study. Oral propranolol prevented the induction of the tachycardias in 18 patients (75%), even after isoproterenol. The shortest R-R interval between two pre-excited complexes in atrial fibrillation increased after propranolol (283 +/- 45 to 343 +/- 95 ms). These results show that oral propranolol increases the EARP of the accessory pathway and the shortest R-R interval between two pre-excited complexes in atrial fibrillation in patients with short anterograde refractory periods of their accessory pathways, and is effective in preventing reciprocating tachycardia. Oral propranolol may be useful and can be used safely in patients with the Wolff-Parkinson-White syndrome.
对24例预激综合征患者研究了口服普萘洛尔的效果。普萘洛尔的平均日剂量为130±24mg，分3次给药，持续48至72小时。在最后一剂后2至4小时进行心腔内电生理研究。在服用普萘洛尔前后（以及在两项研究中，服用异丙肾上腺素前后）测量旁路和正常传导途径的有效前向不应期（EARP）。旁路的EARP不受普萘洛尔影响。然而，在9例其值小于270ms的患者中，该值显著增加（p = 0.01）。在所有口服普萘洛尔的患者中，服用异丙肾上腺素后测量的旁路EARP显著增加（p = 0.001）。在基础电生理研究期间，19例患者可诱发持续性折返性心动过速，另外5例患者可诱发非持续性折返性心动过速。口服普萘洛尔可防止18例患者（75%）诱发心动过速，即使在使用异丙肾上腺素后也是如此。普萘洛尔治疗后，房颤中两个预激复合体之间的最短R-R间期增加（从283±45ms增至343±95ms）。这些结果表明，口服普萘洛尔可增加旁路前向不应期短的患者旁路的EARP以及房颤中两个预激复合体之间的最短R-R间期，并有效预防折返性心动过速。口服普萘洛尔对预激综合征患者可能有用且可安全使用。
