Rothman S A, Jeevanandam V, Seeber C P, Piña I L, Hsia H H, Bove A A, Miller J M
Temple University School of Medicine, Philadelphia, Pa 19140, USA.
J Heart Lung Transplant. 1995 May-Jun;14(3):429-35.
Sinus node dysfunction has been reported to occur in up to 50% of orthotopic heart transplant recipients, and oral theophylline has been used in an attempt to limit the morbidity associated with this abnormality. The purpose of this study was to evaluate the electrophysiologic effects of methylxanthines on sinus node function.
Sinus node testing performed in 26 patients before and after the infusion of 6 mg/kg of aminophylline. Thirteen of these patients had abnormal sinus node function at baseline, and thirteen had normal sinus node function. Sinus node dysfunction was diagnosed by a rhythm other than sinus in five patients, a prolonged corrected sinus node recovery time in two patients, and the presence of a secondary pause in six patients.
In patients with abnormal sinus node function a significant decrease was observed in the sinus node recovery time (-14% +/- 5%) and corrected sinus node recovery time (-33% +/- 25%) in response to aminophylline; however, neither parameter was normalized. A decrease in the sinus cycle length (-6% +/- 8%) was not statistically significant. In patients with normal sinus node function, a significant decrease was seen in both the sinus node recovery time (-9% +/- 7%) and sinus cycle length (-9% +/- 4%). The corrected sinus node recovery time decreased by 4% +/- 28% in patients with normal conditions but was not significant. Overall, aminophylline resolved the underlying sinus node abnormality in only one of thirteen patients with abnormal sinus node function.
This study suggests that the use of theophylline in patients with marked sinus node dysfunction may not decrease their risks for subsequent bradycardic events.
据报道，高达50%的原位心脏移植受者会发生窦房结功能障碍，口服氨茶碱已被用于试图限制与这种异常相关的发病率。本研究的目的是评估甲基黄嘌呤对窦房结功能的电生理作用。
对26例患者在输注6mg/kg氨茶碱前后进行窦房结测试。其中13例患者基线时窦房结功能异常，13例患者窦房结功能正常。5例患者通过非窦性心律诊断为窦房结功能障碍，2例患者通过校正窦房结恢复时间延长诊断，6例患者通过存在继发性停搏诊断。
在窦房结功能异常的患者中，观察到氨茶碱使窦房结恢复时间（-14%±5%）和校正窦房结恢复时间（-33%±25%）显著降低；然而，两个参数均未恢复正常。窦性周期长度降低（-6%±8%）无统计学意义。在窦房结功能正常的患者中，窦房结恢复时间（-9%±7%）和窦性周期长度（-9%±4%）均显著降低。校正窦房结恢复时间在正常情况下的患者中降低了4%±28%，但无统计学意义。总体而言，氨茶碱仅使13例窦房结功能异常患者中的1例潜在窦房结异常得到缓解。
本研究表明，在窦房结功能明显异常的患者中使用氨茶碱可能不会降低其随后发生心动过缓事件的风险。
