Shinohara Tetsuji, Ebata Yuki, Ayabe Reika, Fukui Akira, Okada Norihiro, Yufu Kunio, Nakagawa Mikiko, Takahashi Naohiko
Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan.
Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan.
Heart Rhythm. 2014 Aug;11(8):1441-5. doi: 10.1016/j.hrthm.2014.05.001. Epub 2014 May 6.
Brugada syndrome and idiopathic ventricular fibrillation (VF) associated with inferolateral early repolarization patterns are termed "J-wave syndromes." In such patients, an implantable cardioverter-defibrillator (ICD) is first-line therapy for prevention of sudden cardiac death. However, frequent ICD shocks due to recurrent VF remain serious problems.
The purpose of this study was to ascertain if combination therapy of cilostazol and bepridil could suppress recurrent VF.
We enrolled 7 patients with J-wave syndromes who experienced ICD shocks due to recurrent VF after ICD implantation. At first, cilostazol was instituted. In all subjects, palpitations due to sinus tachycardia caused by cilostazol were symptomatic. Addition of bepridil attenuated cilostazol-induced palpitations and maintained the suppressive effect of cilostazol against VF (87 ± 12 bpm to 66 ± 7 bpm, P < .01).
Six patients remained free of VF. Three patients underwent replacement of the ICD generator 4-5 years after ICD placement. Cilostazol was discontinued 2 days before replacement because of its antiplatelet effects. In all 3 patients, temporary discontinuation of cilostazol led to the reappearance of J waves, culminating in VF and an appropriate ICD shock in 1 patient. J waves disappeared with reinstitution of cilostazol.
These data suggest that combination therapy of cilostazol and bepridil may be effective and safe in suppressing VF recurrence in some cases of J-wave syndromes.
与下侧壁早期复极模式相关的Brugada综合征和特发性室颤被称为“J波综合征”。对于此类患者，植入式心脏复律除颤器（ICD）是预防心源性猝死的一线治疗方法。然而，由于室颤反复发作导致的频繁ICD电击仍是严重问题。
本研究旨在确定西洛他唑和苄普地尔联合治疗能否抑制室颤复发。
我们纳入了7例J波综合征患者，这些患者在植入ICD后因室颤反复发作而经历了ICD电击。首先使用西洛他唑。在所有受试者中，西洛他唑引起的窦性心动过速导致的心悸都有症状。添加苄普地尔可减轻西洛他唑引起的心悸，并维持西洛他唑对室颤的抑制作用（从87±12次/分钟降至66±7次/分钟，P<.01）。
6例患者未再发生室颤。3例患者在ICD植入4至5年后更换了ICD发生器。由于西洛他唑的抗血小板作用，在更换前2天停用了西洛他唑。在所有3例患者中，暂时停用西洛他唑导致J波重现，最终1例患者发生室颤并接受了适当的ICD电击。重新使用西洛他唑后J波消失。
这些数据表明，在某些J波综合征病例中，西洛他唑和苄普地尔联合治疗可能有效且安全地抑制室颤复发。
