Gray R J, Conklin C M, Sethna D H, Mandel W J, Matloff J M
Am Heart J. 1982 Oct;104(4 Pt 1):799-802. doi: 10.1016/0002-8703(82)90014-x.
Although the antiarrhythmic effects of verapamil (V) have been studied widely, its role in the treatment of atrial tachyarrhythmias after open-heart surgery (OHS) has not been defined. Accordingly, 22 patients were studied using a double-blind randomized crossover protocol 1 to 6 days after OHS, except for one patient, who was studied 90 days after OHS. Atrial fibrillation was seen in 18 and atrial flutter was observed in four patients. Two doses were used, 0.075 and 0.15 mg/kg (not exceeding 10 mg per dose), depending on the response. A positive response consisted of: conversion to sinus rhythm or heart rate less than 100 beats/minute (bpm). Eleven patients received V as the first drug; the remaining 11 received placebo first. Digoxin had been given to 20 patients (0.5 mg average dose) prior to inclusion in the study. Four patients converted to sinus rhythm within 30 minutes after V and one additional patient did so within 10 seconds of placebo administration. The post treatment heart rate combining both low and high dose response was 85 +/- 18 compared to 128 +/- 23 bpm for placebo (M +/- SD, p less than 0.01). The heart rate remained lower than control 30 minutes after V. Transient hypotension required intravenous fluid in one patient. Thus, V safely and rapidly controls heart rate but is not likely to result in immediate conversion to sinus rhythm in patients after OHS.
尽管维拉帕米（V）的抗心律失常作用已得到广泛研究，但其在心脏直视手术（OHS）后房性快速性心律失常治疗中的作用尚未明确。因此，对22例患者在OHS后1至6天采用双盲随机交叉方案进行研究，其中1例患者在OHS后90天进行研究。18例患者出现心房颤动，4例患者观察到心房扑动。根据反应情况使用两种剂量，分别为0.075和0.15 mg/kg（每剂不超过10 mg）。阳性反应包括：转为窦性心律或心率低于100次/分钟（bpm）。11例患者首先接受V治疗；其余11例首先接受安慰剂治疗。在纳入研究之前，20例患者已给予地高辛（平均剂量0.5 mg）。4例患者在给予V后30分钟内转为窦性心律，另有1例患者在给予安慰剂后10秒内转为窦性心律。低剂量和高剂量反应合并后的治疗后心率为85±18，而安慰剂组为128±23 bpm（均数±标准差，p<0.01）。给予V后30分钟心率仍低于对照值。1例患者出现短暂性低血压，需要静脉补液。因此，V能安全、迅速地控制心率，但不太可能使OHS后的患者立即转为窦性心律。
