Rozanski J J, Zaman L, Castellanos A
Am J Cardiol. 1982 Feb 18;49(3):621-8. doi: 10.1016/s0002-9149(82)80021-0.
The effects of intravenous diltiazem hydrochloride (0.25 mg/kg body weight) were studied in eight patients with nine episodes of supraventricular tachycardia. Five episodes of tachycardia were due to atrioventricular (A-V) nodal reentry (group A), two were due to retrograde utilization of a concealed A-V accessory pathway (group B) and two were episodes of atrial fibrillation (group C). Intravenous administration of diltiazem slowed the ventricular rate in eight of nine episodes of tachycardias. Supraventricular tachycardia was terminated within 2 minutes after intravenous diltiazem in four of five patients in group A, and one of two in group B. Cycle length alternation was observed before termination of the arrhythmia in two patients from group A. In group C the ventricular response slowed but also became regular during atrial fibrillation. Although diltiazem depressed both anterograde and retrograde conduction as assessed by programmed stimulation, tachycardia termination or slowing or alternation of cycle length all occurred because of the effects of diltiazem predominantly on anterograde A-V nodal properties during supraventricular tachycardia. Although no statistical conclusions can be made from this limited study, it appears that diltiazem has significant depressant electrophysiologic effects on both anterograde and retrograde A-V nodal function as assessed by programmed stimulation during sinus rhythm. Further electrophysiologic studies are needed before determining the clinical efficacy of this agent for treatment or prophylaxis of recurrent supraventricular tachycardias.
对8例患者的9次室上性心动过速发作研究了静脉注射盐酸地尔硫䓬（0.25mg/kg体重）的效果。5次心动过速发作是由于房室（A-V）结折返（A组），2次是由于隐匿性A-V旁路的逆向利用（B组），2次是房颤发作（C组）。静脉注射地尔硫䓬使9次心动过速发作中的8次心室率减慢。A组5例患者中有4例、B组2例中有1例在静脉注射地尔硫䓬后2分钟内室上性心动过速终止。A组2例患者在心律失常终止前观察到周期长度交替。C组在房颤期间心室反应减慢但也变得规则。尽管通过程控刺激评估地尔硫䓬抑制了前向和逆向传导，但心动过速的终止、减慢或周期长度的交替均是由于地尔硫䓬在室上性心动过速期间主要对前向A-V结特性的影响所致。尽管从这项有限的研究中无法得出统计学结论，但在窦性心律期间通过程控刺激评估，地尔硫䓬似乎对前向和逆向A-V结功能均有显著的抑制性电生理作用。在确定该药物治疗或预防复发性室上性心动过速的临床疗效之前，还需要进一步的电生理研究。
