Bonetti F, Margonato A, Mailhac A, Vicedomini G, Cianflone D, Scarpazza P, Chierchia S L
Divisione Cardiologia, Istituto Scientifico San Raffaele, Milano.
Cardiologia. 1990 May;35(5):401-6.
In patients with ischemic heart disease and arrhythmias, selection of antiarrhythmic treatment is often difficult as it is hard to separate "primary" from ischemic arrhythmias. We studied 20 patients with ischemic heart disease, who developed ventricular arrhythmias consistently during exercise test. Exercise test was performed twice during infusion of placebo and then during intravenous administration of nitroglycerin, titrated to reduce systolic blood pressure by 10 mmHg. Exercise duration was 7.8 +/- 1.7 and 7.9 +/- 1.5 min, in the 2 placebo tests (NS). Angina developed in 5 patients and ischemic ST changes in 10. With nitroglycerin exercise duration increased to 8.4 +/- 20 min (p less than 0.05), diagnostic ST segment depression was observed in 2 patients and only 1 had angina. In all 20 patients, ventricular arrhythmias were consistently present during both tests on placebo, that were markedly reduced by nitroglycerin. In fact, ventricular ectopic beats were 455 (mean 35.8 +/- 16.8) and 418 (mean 34.4 +/- 11.1) in the 2 exercise tests with placebo, and 11 during nitroglycerin infusion (mean 0.6 +/- 0.1; p less than 0.001). Couplets were 28 and 29 during placebo (NS) and 0 during nitroglycerin (p less than 0.001). Ventricular tachycardia was present in 6 and 8 patients during placebo but in none during nitroglycerin (p less than 0.001). Reduction of exercise-induced arrhythmias was maintained during chronic treatment with oral vasodilators. Prevention of exercise-related arrhythmias by nitroglycerin infusion appears a good indicator of their ischemic origin and may provide valuable information for long-term profilaxis with oral vasodilators, then avoiding the use of antiarrhythmic agents and their potential side effects.
对于患有缺血性心脏病和心律失常的患者，抗心律失常治疗的选择往往很困难，因为很难将“原发性”心律失常与缺血性心律失常区分开来。我们研究了20例缺血性心脏病患者，他们在运动试验期间持续出现室性心律失常。在输注安慰剂期间和静脉注射硝酸甘油期间各进行了两次运动试验，硝酸甘油的剂量经过调整以使收缩压降低10 mmHg。在两次安慰剂试验中，运动持续时间分别为7.8±1.7分钟和7.9±1.5分钟（无显著性差异）。5例患者出现心绞痛，10例出现缺血性ST段改变。使用硝酸甘油后，运动持续时间增加至8.4±2.0分钟（p<0.05），2例患者出现诊断性ST段压低，只有1例出现心绞痛。在所有20例患者中，安慰剂的两次试验期间均持续出现室性心律失常，而硝酸甘油可使其明显减少。事实上，在两次安慰剂运动试验中，室性早搏分别为455次（平均35.8±16.8次）和418次（平均34.4±11.1次），而在硝酸甘油输注期间为11次（平均0.6±0.1次；p<0.001）。成对早搏在安慰剂期间分别为28次和29次（无显著性差异），在硝酸甘油期间为0次（p<0.001）。安慰剂期间6例和8例患者出现室性心动过速，而硝酸甘油期间无1例出现（p<0.001）。口服血管扩张剂长期治疗期间，运动诱发的心律失常持续减少。硝酸甘油输注预防运动相关心律失常似乎是其缺血性起源的一个良好指标，可为口服血管扩张剂的长期预防提供有价值的信息，进而避免使用抗心律失常药物及其潜在副作用。
