Fujimoto T, Inoue T, Ogawa H, Miwa S, Ohnishi Y, Yoneda N, Kaneda S, Itoh S, Fukuzaki H
First Department of Internal Medicine, Kobe University, School of Medicine, Japan.
Jpn Circ J. 1989 Mar;53(3):237-44. doi: 10.1253/jcj.53.237.
In 11 patients with common type of atrial flutter (common AF), rapid atrial pacing from the high right atrium was performed before and/or after class Ia antiarrhythmic drug administration, confirming transient entrainment by decreasing the pacing cycle length by 10 ms. In 10 patients before the drug administration, common AF was not interrupted although the pacing cycle length was decreased to 200 ms in 5 patients, accelerated atrial flutter or atrial fibrillation was induced in 4 patients, and common AF was converted into sinus rhythm in only 1 patient. After the drug administration common AF was converted into sinus rhythm in 5 out of 6 patients. The class Ia antiarrhythmic drug prolonged the common AF cycle length (255 +/- 12 ms vs. 298 +/- 37 ms, p less than 0.005) and widened the entrainment zone (64 +/- 7 ms vs. 90 +/- 20 ms, p less than 0.05). The widening of the entrainment zone and the prolongation of the common AF cycle length facilitate the successful conversion of common AF at a longer pacing cycle length, which would not precipitate atrial fibrillation or accelerated atrial flutter. The combination therapy of rapid atrial pacing and the class Ia antiarrhythmic drug is thought to be useful in the therapy of common AF.
在11例常见型心房扑动（普通房颤）患者中，在给予I a类抗心律失常药物之前和/或之后，从高位右心房进行快速心房起搏，通过将起搏周期长度缩短10 ms来确认短暂夺获。在10例患者给药前，尽管5例患者的起搏周期长度缩短至200 ms，但普通房颤未被打断，4例患者诱发了加速性心房扑动或心房颤动，仅1例患者的普通房颤转为窦性心律。给药后，6例患者中有5例的普通房颤转为窦性心律。I a类抗心律失常药物延长了普通房颤的周期长度（255±12 ms对298±37 ms，p<0.005），并拓宽了夺获区（64±7 ms对90±20 ms，p<0.05）。夺获区的拓宽和普通房颤周期长度的延长有助于在较长起搏周期长度下成功转复普通房颤，而不会诱发心房颤动或加速性心房扑动。快速心房起搏与I a类抗心律失常药物的联合治疗被认为对普通房颤的治疗有用。
