Gelzer A R M, Kraus M S, Rishniw M, Moïse N S, Pariaut R, Jesty S A, Hemsley S A
Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA.
J Vet Intern Med. 2009 May-Jun;23(3):499-508. doi: 10.1111/j.1939-1676.2009.0301.x.
Atrial fibrillation (AF) with excessively high ventricular rates (VR) occurs in dogs with advanced heart disease. Rate control improves clinical signs in these patients. Optimal drug therapy and target VR remain poorly defined.
Digoxin-diltiazem combination therapy reduces VR more than either drug alone in dogs with high VR AF.
Eighteen client-owned dogs (>15 kg) with advanced heart disease, AF, and average VR on 24-hour Holter > 140 beats per minute (bpm).
After baseline Holter recording, dogs were randomized to digoxin or diltiazem monotherapy, or combination therapy. Repeat Holter evaluation was obtained after 2 weeks; dogs were then crossed over to the other arm (monotherapy or combination therapy) for 2 weeks and a third Holter was acquired. Twenty-four hour average VR, absolute and relative VR changes from baseline, and percent time spent within prespecified VR ranges (>140, 100-140, and <100 bpm) were compared. Correlations between serum drug concentrations and VR were examined.
Digoxin (median, 164 bpm) and diltiazem (median, 158 bpm) decreased VR from baseline (median, 194 bpm) less than the digoxin-diltiazem combination (median, 126 bpm) (P < .008 for each comparison). With digoxin-diltiazem, VR remained <140 bpm for 85% of the recording period, but remained >140 bpm for 88% of the recording period with either monotherapy. Serum drug concentrations did not correlate with VR.
At the dosages used in this study, digoxin-diltiazem combination therapy provided a greater rate control than either drug alone in dogs with AF.
患有晚期心脏病的犬会出现心室率（VR）过高的心房颤动（AF）。控制心率可改善这些患者的临床症状。最佳药物治疗和目标心室率仍未明确界定。
在患有高心室率心房颤动的犬中，地高辛 - 地尔硫䓬联合治疗比单独使用任何一种药物更能降低心室率。
18只客户拥有的犬（体重>15千克），患有晚期心脏病、心房颤动，24小时动态心电图平均心室率>140次/分钟（bpm）。
在进行基线动态心电图记录后，将犬随机分为地高辛单药治疗组、地尔硫䓬单药治疗组或联合治疗组。2周后进行重复动态心电图评估；然后将犬交叉至另一组（单药治疗或联合治疗）2周，并获取第三次动态心电图。比较24小时平均心室率、与基线相比心室率的绝对和相对变化，以及在预先设定的心室率范围（>140、100 - 140和<100 bpm）内花费的时间百分比。检查血清药物浓度与心室率之间的相关性。
地高辛（中位数，164 bpm）和地尔硫䓬（中位数，158 bpm）使心室率较基线（中位数，194 bpm）降低的幅度小于地高辛 - 地尔硫䓬联合治疗（中位数，126 bpm）（每次比较P <.008）。使用地高辛 - 地尔硫䓬联合治疗时，在85%的记录期内心室率保持<140 bpm，但单独使用任何一种单药治疗时，在88%的记录期内心室率保持>140 bpm。血清药物浓度与心室率无相关性。
在本研究使用的剂量下，地高辛 - 地尔硫䓬联合治疗在患有心房颤动的犬中比单独使用任何一种药物能更好地控制心率。
