van Wijk L M, Crijns H J, van Gilst W H, Wesseling H, Lie K I
Department of Cardiology, University Hospital Groningen, The Netherlands.
Am Heart J. 1989 Feb;117(2):365-9. doi: 10.1016/0002-8703(89)90780-1.
Twenty patients with recurrent symptomatic supraventricular tachycardia were studied to estimate the efficacy of flecainide in the long-term treatment of these arrhythmias and to evaluate the prognostic value of programmed electrophysiologic stimulation. All patients had their arrhythmia inducible at baseline evaluation. Nine patients had a Wolff-Parkinson-White (WPW) syndrome, five had a concealed bypass tract, and two had dual atrioventricular (AV) nodal pathways. In the remaining patients there was an intraatrial reentry circuit. Previous medication was no to five antiarrhythmic drugs (mean 2.4 drugs). At baseline, a circus movement tachycardia was induced in 12, AV nodal tachycardia was induced in two, atrial tachycardia was induced in three, atrial fibrillation was induced in five, and a flutter was induced in two patients. After flecainide, 2 mg/kg intravenously in 10 minutes, six patients no longer had their arrhythmia inducible. In the WPW patients, atrial fibrillation was no more inducible. In 65% of the patients there was no recurrence during a follow-up period of 11 +/- 10 months. None of the six patients who no longer had their arrhythmia inducible had a recurrence of the tachycardia over a period of up to 3 years. Seven of the other 14 patients (who still had their arrhythmia inducible) had a recurrence of the tachycardia. Positive and negative predictive values are 50% and 100%, respectively. We conclude that flecainide prevents recurrences of supraventricular tachycardias in 65% of patients with inducible supraventricular tachycardias during a mean follow-up of 11 months. Programmed electrical stimulation has a high negative predictive value in this setting. Flecainide is especially effective in preventing atrial fibrillation in patients with WPW syndrome.
对20例复发性症状性室上性心动过速患者进行了研究，以评估氟卡尼在这些心律失常长期治疗中的疗效，并评估程控电生理刺激的预后价值。所有患者在基线评估时均可诱发心律失常。9例患者患有预激综合征（WPW），5例有隐匿性旁路传导束，2例有双房室（AV）结径路。其余患者存在心房内折返环。既往使用过0至5种抗心律失常药物（平均2.4种药物）。基线时，12例诱发了折返性心动过速，2例诱发了房室结性心动过速，3例诱发了房性心动过速，5例诱发了心房颤动，2例诱发了心房扑动。静脉注射氟卡尼2mg/kg，10分钟内注射完毕后，6例患者不再能诱发心律失常。在WPW患者中，不再能诱发心房颤动。在11±10个月的随访期内，65%的患者未复发。6例不再能诱发心律失常的患者在长达3年的时间内均未出现心动过速复发。其他14例患者（仍能诱发心律失常）中有7例出现心动过速复发。阳性和阴性预测值分别为50%和100%。我们得出结论，在平均11个月的随访期间，氟卡尼可预防65%可诱发室上性心动过速的患者出现室上性心动过速复发。在这种情况下，程控电刺激具有较高的阴性预测价值。氟卡尼在预防WPW综合征患者心房颤动方面特别有效。
