Naito M, Michelson E L, Kmetzo J J, Kaplinsky E, Dreifus L S
Circulation. 1981 Jan;63(1):70-9. doi: 10.1161/01.cir.63.1.70.
Ninety-nine adult mongrel dogs underwent acute ligation of the proximal left anterior descending coronary artery. Thirty minutes later, the occlusion was released to evaluate the effectiveness of five antiarrhythmic protocols in eliminating reperfusion ventricular fibrillation. The five protocols included: protocol 1 --i.v. lidocaine, preligation and prerelease (n = 19); protocol 2 -- i.v. lidocaine, prereperfusion only (n = 22); protocol 3 -- chronic, oral, daily amiodarone for 2 weeks preligation (n = 19); protocol 4 -- i.v. procainamide, preligation and prereperfusion (n = 21); and protocol 5 -- i.v. verapamil, prereperfusion (n = 18). Each regimen was evaluated with respect to the incidence of reperfusion ventricular fibrillation in dogs that survived to reperfusion, and the results were compared to 77 control dogs that underwent identical coronary artery occlusion and release procedures without drug therapy. The incidence of reperfusion ventricular fibrillation was as follows: protocol 1 -- seven of 15 dogs (47%); protocol 2 -- six of 18 (33%); protocol 3 -- 11 of 16 dogs (69%); protocol 4 -- eight of 17 dogs (47%); and protocol 5 -- 10 of 17 dogs (59%), compared with 36 of 60 (60%) in control dogs. Using chi-square analysis, protocol 2 was beneficial (p < 0.05). The dogs were then stratified into high- and low-risk subgroups based on the arrhythmic events of the antecedent coronary artery ligation periods, and predictive risk indexes for the occurrence of reperfusion ventricular fibrillation were developed. the Mantel-Haenszel method of statistical analysis revealed that none of these protocols resulted in a statistically significant reduction in the incidence of reperfusion ventricular fibrillation. Thus, use of these predictive indexes plus appropriate statistical methods has revealed, unexpectedly, limitations in the efficacy of a spectrum of antiarrhythmic agents in preventing reperfusion ventricular fibrillation.
99只成年杂种犬接受了左冠状动脉前降支近端的急性结扎。30分钟后，解除结扎以评估五种抗心律失常方案消除再灌注性室颤的有效性。这五种方案包括：方案1——静脉注射利多卡因，结扎前及解除结扎前使用（n = 19）；方案2——仅在再灌注前静脉注射利多卡因（n = 22）；方案3——结扎前2周每天口服胺碘酮（n = 19）；方案4——静脉注射普鲁卡因胺，结扎前及再灌注前使用（n = 21）；方案5——再灌注前静脉注射维拉帕米（n = 18）。对每种方案，评估存活至再灌注的犬发生再灌注性室颤的发生率，并将结果与77只接受相同冠状动脉结扎和解除结扎操作但未接受药物治疗的对照犬进行比较。再灌注性室颤的发生率如下：方案1——15只犬中有7只（47%）；方案2——18只中有6只（33%）；方案3——16只犬中有11只（69%）；方案4——17只犬中有8只（47%）；方案5——17只犬中有10只（59%），而对照犬为60只中有36只（60%）。使用卡方分析，方案2有益（p < 0.05）。然后根据先前冠状动脉结扎期的心律失常事件将犬分为高风险和低风险亚组，并制定了再灌注性室颤发生的预测风险指数。Mantel-Haenszel统计分析方法显示，这些方案均未使再灌注性室颤的发生率有统计学意义的降低。因此，使用这些预测指数及适当的统计方法意外地揭示了一系列抗心律失常药物在预防再灌注性室颤方面疗效的局限性。
