Pugsley M K, Ries C R, Guppy L J, Harvie C J, Walker M J
Department of Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
Life Sci. 1995;57(12):1219-31. doi: 10.1016/0024-3205(95)02070-y.
In this study we examined the cardiovascular and possible antiarrhythmic actions of anipamil, a long acting analog of verapamil. Initial dose-response studies for anipamil (0.25-6.0 mg/kg, i.v.) in pentobarbitone-anesthetized pigs (n = 4) were conducted to determine the effects of the drug on EKG and hemodynamic measures. In this initial study anipamil was found to produce a dose-dependent reduction in blood pressure, left-ventricular pressure and its derivative (dP/dtmax), cardiac output, and increase in heart rate. These results were used as a basis from which to choose doses for a second study to assess antiarrhythmic actions of anipamil against arrhythmias induced by regional myocardial ischemia. The antiarrhythmic effects of the two doses were compared with verapamil when the latter was given at a dose producing cardiovascular effects mid-way between those produced by the two doses of anipamil. Anesthetized pigs were randomly assigned to receive one of three drug treatments, or vehicle control, prior to occlusion of the left-anterior descending coronary artery. Antiarrhythmic effectiveness of low (1.0 mg/kg + 0.10 mg/kg/min infusion, n = 8) and high (5.0 mg/kg + 0.50 mg/kg/min infusion, n = 12) dose anipamil was compared to that of verapamil (0.5 mg/kg + 0.60 mg/kg/min infusion, n = 8) in a vehicle controlled study (n = 15). Arrhythmic events (VPB, VT and VF incidence) were monitored and grouped according to their time of occurrence after occlusion. Thus phase 1a arrhythmias occurred 0-5 min after initiation of occlusion, phase 1b, 5-30 min, and phase 2, 0.5-4 hr after occlusion. This study showed that during phase 1a there was a low incidence of arrhythmias in all groups except the one receiving 5 mg/kg anipamil where the group incidence of VT was 58% as compared to 20% in controls (n = 15). Most ventricular arrhythmias occurred in all groups during phase 1b. In this phase verapamil abolished VF and reduced VT, as compared with controls. Anipamil (high and low doses) tended to reduce VT but not VF. In the period 0.5 to 4 hours post occlusion (phase 2) all three drug treatments were associated with fewer arrhythmias but this only reached statistical significance with verapamil. Thus verapamil was more efficacious than anipamil at providing antiarrhythmic protection against both early and late onset arrhythmias. Anipamil may have been proarrhythmic in the early phase of arrhythmias and only moderately antiarrhythmic, if at all, in the later phase.(ABSTRACT TRUNCATED AT 400 WORDS)
在本研究中,我们检测了维拉帕米长效类似物阿尼帕米的心血管作用及可能的抗心律失常作用。对戊巴比妥麻醉的猪(n = 4)进行了阿尼帕米(0.25 - 6.0 mg/kg,静脉注射)的初始剂量反应研究,以确定该药物对心电图和血流动力学指标的影响。在这项初始研究中,发现阿尼帕米可使血压、左心室压力及其变化率(dP/dtmax)、心输出量呈剂量依赖性降低,并使心率增加。这些结果被用作选择剂量的依据,以进行第二项研究,评估阿尼帕米对局部心肌缺血诱导的心律失常的抗心律失常作用。当维拉帕米以产生介于阿尼帕米两剂量所产生心血管效应中间值的剂量给药时,将两剂量阿尼帕米的抗心律失常作用与维拉帕米进行比较。在左前降支冠状动脉闭塞前,将麻醉的猪随机分配接受三种药物治疗之一或赋形剂对照。在一项赋形剂对照研究(n = 15)中,比较了低剂量(1.0 mg/kg + 0.10 mg/kg/min输注,n = 8)和高剂量(5.0 mg/kg + 0.50 mg/kg/min输注,n = 12)阿尼帕米与维拉帕米(0.5 mg/kg + 0.60 mg/kg/min输注,n = 8)的抗心律失常效果。监测心律失常事件(室性早搏、室性心动过速和室颤发生率),并根据其在闭塞后发生的时间进行分组。因此,1a期心律失常发生在闭塞开始后0 - 5分钟,1b期为5 - 30分钟,2期为闭塞后0.5 - 4小时。本研究表明,在1a期,除接受5 mg/kg阿尼帕米的组外,所有组的心律失常发生率均较低,该组室性心动过速的组发生率为58%,而对照组为20%(n = 15)。大多数室性心律失常发生在所有组的1b期。在此阶段,与对照组相比,维拉帕米消除了室颤并减少了室性心动过速。阿尼帕米(高剂量和低剂量)倾向于减少室性心动过速,但不能减少室颤。在闭塞后0.5至4小时期间(2期),所有三种药物治疗均与较少的心律失常相关,但仅维拉帕米达到统计学意义。因此,在提供针对早期和晚期发作心律失常的抗心律失常保护方面,维拉帕米比阿尼帕米更有效。阿尼帕米在心律失常早期可能具有促心律失常作用,而在后期即使有抗心律失常作用也很适度。(摘要截短至400字)