Nelson S D, Lenhart M B, Saffarin A
Division of Cardiology, Ohio State University, Columbus, USA.
Pacing Clin Electrophysiol. 1996 Nov;19(11 Pt 1):1568-73. doi: 10.1111/j.1540-8159.1996.tb03182.x.
The sodium channel-blocking actions of some Class I antiarrhythmic agents can increase the defibrillation energy requirements (DER) of monophasic shock waveforms. The influence of sodium channel blockade on biphasic shocks is less certain. The purpose of this study was to compare, in a randomized, placebo controlled study, the influence of lidocaine on the DER of biphasic and monophasic shock waveforms in a canine model of transvenous internal defibrillation. The DER was determined by the iterative increment-decrement protocol. Monophasic and biphasic shock DERs were tested at baseline and during lidocaine infusion (group A) or saline control (group B). Group A biphasic shock DERs increased significantly from a baseline of 12.1 +/- 3.6 J to 19.1 +/- 9.3 J when compared to group B (P = 0.005). In group A, the mean DER during lidocaine was significantly higher with monophasic shocks than biphasic shocks (29.6 +/- 11.8 J vs 19.1 +/- 9.3 J, respectively; P < 0.003), but the magnitude of change in biphasic versus monophasic shock DERs was not significantly different (F = 1.78; p = 0.193). There was a linear relationship between the baseline DER and the DER during lidocaine (r2 = 0.63, P < 0.0001). Sodium channel blockade with lidocaine increases the DER of both monophasic and biphasic shocks. However, the DER of biphasic shocks during lidocaine are significantly lower than monophasic shock DERs, a finding that can be explained by the linear relationship between the baseline DER and the DER during lidocaine. These results may have favorable implications for the use of Class I antiarrhythmics with biphasic shock defibrillators.
某些Ⅰ类抗心律失常药物的钠通道阻滞作用可增加单相电击波形的除颤能量需求（DER）。钠通道阻滞对双相电击的影响尚不确定。本研究的目的是在一项随机、安慰剂对照研究中，比较利多卡因对经静脉体内除颤犬模型中双相和单相电击波形DER的影响。DER通过迭代增减方案确定。在基线时以及利多卡因输注期间（A组）或生理盐水对照期间（B组）测试单相和双相电击DER。与B组相比，A组双相电击DER从基线的12.1±3.6 J显著增加至19.1±9.3 J（P = 0.005）。在A组中，利多卡因作用期间单相电击的平均DER显著高于双相电击（分别为29.6±11.8 J和19.1±9.3 J；P < 0.003），但双相电击与单相电击DER的变化幅度无显著差异（F = 1.78；p = 0.193）。基线DER与利多卡因作用期间的DER之间存在线性关系（r2 = 0.63，P < 0.0001）。利多卡因引起的钠通道阻滞增加了单相和双相电击的DER。然而，利多卡因作用期间双相电击的DER显著低于单相电击的DER，这一发现可用基线DER与利多卡因作用期间的DER之间的线性关系来解释。这些结果可能对Ⅰ类抗心律失常药物与双相电击除颤器的联合使用具有有利意义。
