Shinohara Masaya, Fujino Tadashi, Koike Hideki, Kitahara Ken, Kinoshita Toshio, Yuzawa Hitomi, Suzuki Takeya, Fukunaga Shunji, Kobayashi Kenzaburo, Aoki Jiro, Tanabe Kengo, Ikeda Takanori
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
J Cardiol. 2017 Sep;70(3):212-219. doi: 10.1016/j.jjcc.2017.01.008. Epub 2017 Mar 24.
The autonomic nervous system involves the genesis of premature ventricular contractions (PVCs). Previous studies demonstrated that heart rate (HR) dependency of idiopathic PVCs has different autonomic mechanisms. Recently, the bisoprolol patch, a novel transdermal β1-blocker formulation containing bisoprolol, became clinically available. We examined the efficacy of the bisoprolol patch for treating frequent PVCs in patients without structural heart disease (SHD) regarding the HR dependency of PVCs.
This prospective study included 44 consecutive patients without SHD (25 men, mean age, 63.6±12.3 years) with PVC counts≥3000 beats as measured by 24-hour Holter electrocardiograms (ECGs). PVCs were divided into positive HR-dependent PVCs (P-PVCs) and non-positive HR-dependent PVCs (NP-PVCs) based on the relationship between the hourly PVC density and hourly mean HR. A bisoprolol patch was administered once daily at a dose of 4mg. The 24-hour Holter ECGs were performed before and 1 month after the initiation of the therapy.
In 44 patients, there were 24 P-PVCs and 20 NP-PVCs. The bisoprolol patch reduced the PVC count significantly (from 16,563±10,056 to 7892±8817 beats/24hours, p<0.001) in the P-PVC group, while the PVC count did not change significantly (from 16,409±9571 to 13,476±12,191beats/24hours, p=0.34) in the NP-PVC group. Moreover, in the P-PVC group, the patients with mean HRs ≥80 beats/minute had a significantly higher percent improvement in the PVC count than those with mean HRs <80 beats/minute (p=0.0080). The bisoprolol patch resulted in a significant reduction in the PVC count from baseline during each time period for the changes within a 24-hour period in the P-PVC group.
The transdermal bisoprolol patch was effective for a PVC reduction in patients with P-PVCs, particularly in those with faster mean HRs. Furthermore, it demonstrated a stable PVC-reducing effect during the 24-hour period in the P-PVC group.
自主神经系统与室性早搏（PVC）的发生有关。既往研究表明，特发性PVC的心率（HR）依赖性存在不同的自主神经机制。最近，比索洛尔贴片，一种含有比索洛尔的新型透皮β1受体阻滞剂制剂，已在临床上可用。我们研究了比索洛尔贴片在治疗无结构性心脏病（SHD）患者频发PVC方面对PVC心率依赖性的疗效。
这项前瞻性研究纳入了44例连续的无SHD患者（25例男性，平均年龄63.6±12.3岁），其PVC计数通过24小时动态心电图（ECG）测量≥3000次。根据每小时PVC密度与每小时平均HR之间的关系，将PVC分为阳性HR依赖性PVC（P-PVC）和非阳性HR依赖性PVC（NP-PVC）。比索洛尔贴片每天给药一次，剂量为4mg。在治疗开始前和开始后1个月进行24小时动态心电图检查。
44例患者中，有24例P-PVC和20例NP-PVC。比索洛尔贴片使P-PVC组的PVC计数显著降低（从16563±10056次/24小时降至7892±8817次/24小时，p<0.001），而NP-PVC组的PVC计数无显著变化（从16409±9571次/24小时降至13476±12191次/24小时，p=0.34）。此外，在P-PVC组中，平均HR≥80次/分钟的患者PVC计数改善百分比显著高于平均HR<80次/分钟的患者（p=0.0080）。比索洛尔贴片使P-PVC组24小时内各时间段的PVC计数较基线显著降低。
透皮比索洛尔贴片对降低P-PVC患者的PVC有效，尤其是平均HR较快的患者。此外，它在P-PVC组的24小时内显示出稳定的降低PVC的效果。
