Goldstein R A, Geraci S A, Gray E L, Rinkenberger R L, Dougherty A H, Naccarelli G V
Am J Cardiol. 1986 Mar 1;57(8):624-8. doi: 10.1016/0002-9149(86)90847-7.
The electrophysiologic effects of milrinone, a new inotropic agent, have not been characterized in humans. Accordingly, 10 patients with class III or IV congestive heart failure underwent hemodynamic and electrophysiologic testing before and during an infusion of milrinone (0.5 micrograms/kg/min). Cardiac index increased from a mean of 1.65 +/- 0.51 to 2.19 +/- 0.68 liters/min/m2 (p less than 0.03) and pulmonary artery capillary pressure decreased from 30 +/- 9 to 22 +/- 9 mm Hg (p less than 0.01), without a significant change in systemic arterial pressure. Holter monitoring was performed for 48 hours at baseline and during infusion of milrinone. Frequency of ventricular premature complexes and ventricular couplets did not change significantly. Frequency of ventricular tachycardia (VT) increased significantly, although no patients would be classified as having a proarrhythmic effect based on a clinical model. PR, QRS, QTc, heart rate, AH, HV, atrial, atrioventricular and ventricular effective and functional refractory periods were not affected. Milrinone decreased 1:1 atrioventricular maximal conduction from 399 +/- 133 to 374 +/- 111 ms (p less than 0.01); ventriculoatrial conduction was not significantly affected. During programmed right ventricular stimulation, 5 patients had inducible VT at baseline (3 sustained, 2 non-sustained), whereas after drug administration, none had it (p less than 0.05). Thus, intravenous milrinone is an effective inotropic drug that also enhances atrioventricular conduction and may decrease the incidence of inducible VT in patients with congestive heart failure.
新型正性肌力药物米力农的电生理效应尚未在人体中得到明确描述。因此，对10例Ⅲ级或Ⅳ级充血性心力衰竭患者在输注米力农（0.5微克/千克/分钟）之前及期间进行了血流动力学和电生理检测。心脏指数从平均1.65±0.51升至2.19±0.68升/分钟/平方米（p<0.03），肺动脉毛细血管压从30±9降至22±9毫米汞柱（p<0.01），而体循环动脉压无显著变化。在基线及米力农输注期间进行了48小时的动态心电图监测。室性早搏和室性成对早搏的频率无显著变化。室性心动过速（VT）的频率显著增加，尽管根据临床模型无患者被归类为具有促心律失常作用。PR、QRS、QTc、心率、AH、HV、心房、房室及心室有效和功能不应期均未受影响。米力农使1:1房室最大传导时间从399±133毫秒降至374±111毫秒（p<0.01）；室房传导未受显著影响。在程控右心室刺激期间，5例患者在基线时有可诱发的VT（3例持续性，2例非持续性），而用药后无患者出现（p<0.05）。因此，静脉注射米力农是一种有效的正性肌力药物，还可增强房室传导，并可能降低充血性心力衰竭患者可诱发VT的发生率。
