Brugada P, Abdollah H, Wellens H J
J Am Coll Cardiol. 1984 Dec;4(6):1255-60. doi: 10.1016/s0735-1097(84)80146-1.
Although uncommon, incessant supraventricular tachycardia (the daily presence of supraventricular tachycardia for more than 50% of the day) is a major therapeutic problem. Using programmed electrical stimulation of the heart, long-term electrocardiographic monitoring and exercise testing, the effect of intravenous and oral encainide for termination and prevention of incessant supraventricular tachycardia was assessed in 11 patients (aged 25 to 58 years). All patients had received 3 to 12 drugs (mean 6) without control of their arrhythmia. Eight patients suffered from incessant supraventricular tachycardia using an accessory pathway in retrograde direction (three with overt Wolff-Parkinson-White syndrome, one with a concealed accessory atrioventricular [AV] pathway of the fast type, three with a concealed accessory AV pathway of the slow type and one with a nodo-ventricular accessory pathway). Three patients had incessant atrial tachycardia, one of whom also had the Wolff-Parkinson-White syndrome. Intravenous encainide (1.5 mg/kg in 15 minutes) terminated incessant supraventricular tachycardia in seven of nine patients. In four of nine patients, supraventricular tachycardia could thereafter still be reinitiated by pacing. Oral encainide (100 to 325 mg/day, mean 180) completely suppressed the incessant supraventricular tachycardia in eight patients in a follow-up period of 5 to 20 months (mean 11). In two patients, episodes of tachycardia were markedly reduced with the administration of encainide in combination with sotalol (one patient) and amiodarone (one patient). Encainide failed to control incessant tachycardia in one patient. Mild central nervous system side effects developed in two patients, but both could continue taking oral encainide. Encainide proved to be a very useful agent to control incessant supraventricular tachycardia resistant to other antiarrhythmic agents.
虽然不常见，但持续性室上性心动过速（即室上性心动过速每天发作时间超过全天的50%）是一个主要的治疗难题。通过心脏程控电刺激、长期心电图监测和运动试验，对11例年龄在25至58岁之间的患者评估了静脉注射和口服恩卡胺对终止和预防持续性室上性心动过速的效果。所有患者此前已接受3至12种药物治疗（平均6种），但其心律失常仍未得到控制。8例患者存在逆向使用附加旁路的持续性室上性心动过速（3例为显性预激综合征，1例为快速型隐匿性房室附加旁路，3例为慢速型隐匿性房室附加旁路，1例为结室附加旁路）。3例患者有持续性房性心动过速，其中1例还患有预激综合征。静脉注射恩卡胺（15分钟内注射1.5mg/kg）使9例患者中的7例持续性室上性心动过速终止。9例患者中有4例，此后仍可通过起搏重新诱发室上性心动过速。口服恩卡胺（100至325mg/天，平均180mg）在5至20个月（平均11个月）的随访期内使8例患者的持续性室上性心动过速完全得到抑制。在2例患者中，联合使用索他洛尔（1例）和胺碘酮（1例）并给予恩卡胺后，心动过速发作明显减少。恩卡胺未能控制1例患者的持续性心动过速。2例患者出现轻度中枢神经系统副作用，但均可继续服用口服恩卡胺。事实证明，恩卡胺是控制对其他抗心律失常药物耐药的持续性室上性心动过速的一种非常有用的药物。
