Kessler K M, McAuliffe D, Kozlovskis P, Trohman R G, Zaman L, Castellanos A, Sequeira R, Myerburg R J
Department of Medicine, University of Miami School of Medicine, Florida.
Am J Cardiol. 1988 Mar 1;61(8):563-9. doi: 10.1016/0002-9149(88)90765-5.
The effect of an infusion of intravenous procainamide on the frequency of ventricular premature complexes (VCPs) of differing QRS morphologies was studied in 20 patients with multiform ectopic activity. In 17 of 20 patients, there was differential suppression of single VPCs with different QRS morphologies. VPCs of the most frequent QRS morphology and the second most frequent QRS morphology were compared with respect to the procainamide level at the escape of VPCs from 85% suppression and the duration of suppression measured from the onset of the procainamide infusion. In 8 patients, VPCs of the most frequent QRS morphology remained suppressed at lower procainamide concentrations and for longer times than did VPCs of the second most frequent QRS morphology (escape procainamide concentration = 2.8 +/- 1.7 versus 5.4 +/- 2.3 micrograms/ml, p less than 0.025; time to escape 244 +/- 138 versus 98 +/- 114 min; p less than 0.05). In 9 other patients, VPCs of the second most frequent QRS morphology remained suppressed at lower procainamide concentrations and for longer times than did VPCs of the most frequent QRS morphology (escape procainamide concentration 2.9 +/- 1.4 versus 8.3 +/- 6.3 micrograms/ml, p less than 0.025; time to escape 317 +/- 114 versus 63 +/- 80 min; p less than 0.001). Thus, in individual patients there are specific patterns of suppression of VPCs of different QRS morphologies which are independent of the frequency of each morphology. There is apparently a differential pharmacologic effect of procainamide on the foci or pathways responsible for the different QRS morphologies of multiform VPCs.
在20例有多形性异位活动的患者中，研究了静脉输注普鲁卡因胺对不同QRS形态的室性早搏（VPC）频率的影响。20例患者中有17例，不同QRS形态的单个VPC受到不同程度的抑制。比较了最常见QRS形态和第二常见QRS形态的VPC在VPC从85%抑制中逸出时的普鲁卡因胺水平，以及从普鲁卡因胺输注开始测量的抑制持续时间。在8例患者中，最常见QRS形态的VPC在较低的普鲁卡因胺浓度下被抑制的时间比第二常见QRS形态的VPC更长（逸出时普鲁卡因胺浓度=2.8±1.7对5.4±2.3微克/毫升，p< .025；逸出时间244±138对98±114分钟；p< .05）。在另外9例患者中，第二常见QRS形态的VPC在较低的普鲁卡因胺浓度下被抑制的时间比最常见QRS形态的VPC更长（逸出时普鲁卡因胺浓度2.9±1.4对8.3±6.3微克/毫升，p< .025；逸出时间317±114对63±80分钟；p< .001）。因此，在个体患者中，存在不同QRS形态的VPC的特定抑制模式，这与每种形态的频率无关。普鲁卡因胺对导致多形性VPC不同QRS形态的病灶或途径显然有不同的药理作用。
