Neuss H, Golling F R, Schlepper M, Thormann J, Weissmüller P, Kindler M
Z Kardiol. 1984 Feb;73(2):106-12.
In 13 patients with chronic atrial fibrillation, programmed right ventricular pacing was performed before and after intravenous administration of 4 mg gallopamil. Application of the Ca-antagonist resulted in a marked decrease in the ventricular response in all and in a regularization of the ventricular response (variation coefficient of the ventricular cycle length: less than 10%) in 7 of 13 cases, while atrial fibrillation persisted. During regularization right ventricular extrastimulus testing showed a constancy of the postextrasystolic interval irrespective of the changes in the coupling interval of the extrasystole. The postextrasystolic cycle was slightly longer than the basic cycle; the difference amounts to a mean value of 107 +/- 22 ms. During the control period the postextrasystolic cycle showed the same irregularity as the basic cycle. The same random distribution was observed if the first 10 cycles of the spontaneous rhythm were analyzed after a short period of ventricular overdrive pacing. After regularization the first 2-3 postpacing cycles were markedly prolonged, and during the following cycles a gradual adjustment to the length of the basic cycles before overdrive pacing was seen, resembling the warming up of a pacemaker. It is concluded that regularization is most probably due to atrioventricular nodal depression and the occurrence of a junctional escape pacemaker.
对13例慢性心房颤动患者，在静脉注射4mg加洛帕米前后进行了程控右心室起搏。应用钙拮抗剂后，所有患者的心室反应均显著降低，13例中有7例心室反应变得规则（心室周期长度变异系数小于10%），而心房颤动持续存在。在心室反应规则化期间，右心室期外刺激试验显示，不管期外收缩的联律间期如何变化，代偿间歇均保持恒定。代偿间歇期比基本周期略长；差值的平均值为107±22毫秒。在对照期，代偿间歇期与基本周期表现出相同的不规则性。在短时间心室超速起搏后分析自发节律的前10个周期时，也观察到相同的随机分布。在心室反应规则化后，起搏后的前2 - 3个周期明显延长，在随后的周期中，逐渐调整至超速起搏前基本周期的长度，类似于起搏器的预热。结论是，心室反应规则化很可能是由于房室结抑制和交界性逸搏起搏器的出现。
