Coumel P, Leclercq J F, Assayag P, Maisonblanche P, Cauchemez B
Arch Mal Coeur Vaiss. 1984 Nov;77(12):1370-82.
During a 3 year period, seventy patients aged 53 +/- 16 years with a total of 73 arrhythmias were treated over a mean period of 6.8 months (maximum 27 months) with oral propafenone, the usual dose being 900 mg/day. The study covered the whole spectrum of cardiac arrhythmias (32 supraventricular, 41 ventricular), and their relation to the autonomic nervous system. The efficacy was scored from 1 (no effect) to 5 (complete control) as judged by the clinical response, the results of Holter monitoring (175 control and 133 test recordings on therapy), and a comparison was made between the effects of propafenone and other antiarrhythmics: quinidine-like drugs, beta-blockers and amiodarone. With respect to supraventricular arrhythmias: 9 cases of vagally-induced atrial flutter and fibrillation were unaffected by propafenone (mean score = 1.1). On the other hand, the drug was very effective (mean score = 4.1) in 8 cases of adrenergic atrial arrhythmias. In 12 arrhythmias with more varied mechanisms (extrasystoles, tachysystole, paroxysmal atrial fibrillation) an intermediate score was obtained (2.8). Three cases of resistant junctional tachycardia due to reentry were improved. At ventricular level, 5 cases of extrasystole sensitive to quinidine were also improved by propafenone (4.6); the difference was more clearcut in 8 cases of benign idiopathic tachycardia (propafenone: 4.1, and quinidine: 2.4). This was more marked in 13 cases of more severe arrhythmia in diseased hearts in which the effect of propafenone (4.1) was superior even to that of amiodarone. However, propafenone was less effective (3.3) than amiodarone in 4 cases of severe polymorphic idiopathic ventricular tachycardia closely related to the autonomic nervous system. The antiarrhythmic effect of propafenone was appreciable in 10 cases of resistant post-infarction ventricular tachycardia, eventually in association with amiodarone. Slowing of the sinus rhythm (-11.6%) with no change in the day/night ratio was due to beta-inhibition. However, in toxic doses this may progress to sinoatrial block (9 cases). A lengthening of the PR interval and duration of QRS was common, but this was not complicated by torsade de pointes, one case of which was successfully treated by propafenone. Secondary gastro-intestinal effects and vertigo were rarely severe enough to warrant stopping therapy. In conclusion, these results show that the introduction of propafenone is a valuable therapeutic advance in the treatment of arrhythmias, especially in those with a favoring adrenergic mechanism.
在3年期间，70名年龄为53±16岁、共有73例心律失常的患者接受了平均6.8个月（最长27个月）的口服普罗帕酮治疗，常用剂量为900毫克/天。该研究涵盖了心律失常的整个范围（32例室上性、41例室性）及其与自主神经系统的关系。根据临床反应、动态心电图监测结果（治疗期间175次对照记录和133次测试记录），疗效评分为1分（无效果）至5分（完全控制），并对普罗帕酮与其他抗心律失常药物（奎尼丁类药物、β受体阻滞剂和胺碘酮）的效果进行了比较。关于室上性心律失常：9例迷走神经诱发的心房扑动和颤动不受普罗帕酮影响（平均评分为1.1）。另一方面，该药物对8例肾上腺素能性房性心律失常非常有效（平均评分为4.1）。在12例机制更为多样的心律失常（早搏、快速性心律失常、阵发性心房颤动）中，获得了中间评分（2.8）。3例因折返引起的顽固性交界性心动过速有所改善。在心室水平，5例对奎尼丁敏感的早搏也因普罗帕酮而改善（4.6）；在8例良性特发性心动过速中差异更为明显（普罗帕酮：4.1，奎尼丁：2.4）。在13例患病心脏中更为严重的心律失常中更为显著，其中普罗帕酮的效果（4.1）甚至优于胺碘酮。然而，在4例与自主神经系统密切相关的严重多形性特发性室性心动过速中，普罗帕酮的效果（3.3）不如胺碘酮。普罗帕酮对10例顽固性梗死后室性心动过速有明显的抗心律失常作用，最终可能与胺碘酮联合使用。窦性心律减慢（-11.6%）且昼夜比值无变化是由于β受体抑制。然而，在中毒剂量下，这可能进展为窦房阻滞（9例）。PR间期和QRS时限延长很常见，但未并发尖端扭转型室速，其中1例经普罗帕酮成功治疗。继发性胃肠道效应和眩晕很少严重到需要停止治疗。总之，这些结果表明，普罗帕酮的引入是心律失常治疗中一项有价值的治疗进展，尤其是在那些具有有利肾上腺素能机制的心律失常中。
