Sadanaga T, Ogawa S, Okada Y, Tsutsumi N, Iwanaga S, Yoshikawa T, Akaishi M, Handa S
Department of Medicine, Keio University, School of Medicine, Tokyo, Japan.
Am Heart J. 1993 Jul;126(1):114-21. doi: 10.1016/s0002-8703(07)80017-2.
We measured the QRS duration during a treadmill exercise test and the QT interval using a 24-hour Holter electrocardiogram at various heart rates to identify use-dependent QRS prolongation and reverse use-dependent QT prolongation of class I and III antiarrhythmic drugs. Use-dependent QRS prolongation was detected in 61%, 53%, and 64% of patients receiving disopyramide, mexiletine, and pilsicainide, respectively. Reverse use-dependent QT prolongation was found in 40% and 70% of patients receiving disopyramide and E4031. Drugs suppressed > or = 75% of the total premature ventricular contractions in all patients who had both use-dependent QRS prolongation and reverse use-dependent QT prolongation, in 79% of patients with use-dependent QRS prolongation alone, in 70% with reverse use-dependent QT prolongation alone, and in 11% with neither use-dependent QRS prolongation nor reverse use-dependent QT prolongation. Use-dependent QRS prolongation and reverse use-dependent QT prolongation were identified noninvasively and were useful in evaluating antiarrhythmic efficacy.
我们在跑步机运动试验期间测量QRS时限，并使用24小时动态心电图在不同心率下测量QT间期，以确定Ⅰ类和Ⅲ类抗心律失常药物的使用依赖性QRS延长和反向使用依赖性QT延长。分别在61%、53%和64%接受丙吡胺、美西律和吡西卡尼的患者中检测到使用依赖性QRS延长。在40%和70%接受丙吡胺和E4031的患者中发现反向使用依赖性QT延长。在所有同时有使用依赖性QRS延长和反向使用依赖性QT延长的患者中，药物抑制了≥75%的室性早搏总数；在仅具有使用依赖性QRS延长的患者中，这一比例为79%；在仅具有反向使用依赖性QT延长的患者中为70%；在既无使用依赖性QRS延长也无反向使用依赖性QT延长的患者中为11%。使用依赖性QRS延长和反向使用依赖性QT延长可通过无创方式识别，且有助于评估抗心律失常疗效。
