Sung R J, Elser B, McAllister R G
Ann Intern Med. 1980 Nov;93(5):682-9. doi: 10.7326/0003-4819-93-5-682.
We evaluated efficacy and mechanisms of the antiarrhythmic action of verapamil in 20 patients with sustained supraventricular tachycardia. Two patients had sinus nodal re-entrant tachycardia, nine atrioventricular (AV) nodal re-entrant tachycardia, and nine AV reciprocating tachycardia associated with the Wolff-Parkinson-White syndrome. The study design comprised a double-blind, randomized, cross-over phase using a 0.075 mg/kg dose of verapamil versus placebo and an open-label phase using a 0.15 mg/kg dose of verapamil. The overall results of both phases showed that 15 of 19 patients converted to sinus rhythm with verapamil while only one of 16 converted to sinus rhythm with placebo. The effective plasma verapamil concentration measured 123 +/- 40 ng/mL (mean +/- SD). Verapamil suppressed sinus nodal and AV nodal re-entry but exerted no selective depression between fast and slow AV nodal pathways. It had no significant effect on accessory AV bypass tract but was effective in terminating AV reciprocating tachycardia by its depressive action on the AV node.
我们评估了维拉帕米对20例持续性室上性心动过速患者抗心律失常作用的疗效及机制。其中2例为窦房结折返性心动过速，9例为房室结折返性心动过速，9例为与预激综合征相关的房室折返性心动过速。研究设计包括一个双盲、随机、交叉阶段，使用0.075mg/kg剂量的维拉帕米与安慰剂对比，以及一个开放标签阶段，使用0.15mg/kg剂量的维拉帕米。两个阶段的总体结果显示，19例使用维拉帕米的患者中有15例转为窦性心律，而16例使用安慰剂的患者中只有1例转为窦性心律。测得的维拉帕米有效血浆浓度为123±40ng/mL（平均值±标准差）。维拉帕米可抑制窦房结和房室结折返，但对房室结快径路和慢径路无选择性抑制作用。它对房室旁路无明显作用，但通过对房室结的抑制作用有效终止房室折返性心动过速。
