Effects of Verapamil and Procainamide on Acute Atrial Electrical Remodeling Induced by Short-Term Rapid Atrial Pacing in Humans

Verapamil及Procainamide對於人體心房組織短期快速電刺激所誘發的電氣重塑效應之影響

朱志生(Chih-Sheng Chu) ； 李坤泰(Kun-Tai Lee) ； 鄭凱鴻(Kai-Hong Cheng) ； 林宗憲(Tsung-Hsien Lin) ； 李明義(Min-Yi Lee) ； 溫文才(Wen-Chol Voon) ； 許勝雄(Sheng-Hsiung Sheu) ； 賴文德(Wen-Ter Lai)

《The Kaohsiung Journal of Medical Sciences》 23卷12期 (2007/12) Pp. 599-610

摘要

Atrial electrical remodeling (ER) after spontaneous or pacing-induced atrial fibrillation has been previously described in humans. We investigated atrial ER induced by a 5-minute period of rapid atrial pacing and the pharmacologic effects of verapamil and procainamide on this atrial ER phenomenon. The atrial effective refractory periods (ERPs) at drive cycle lengths of 400 (ERP400) and 600 (ERP600) ms, at five representative atrial sites (high right atrium [HRA]; proximal, middle and distal coronary sinus; interatrial septum), were determined in 20 patients at baseline and immediately after cessation of a 5-minute period of rapid pacing from the HRA at a rate of 150 bpm. The degrees of atrial ERP400 and ERP600 shortening after pacing were calculated as acute atrial ER. The same protocol was repeated in another 15 patients after intravenous administration of verapamil (0.15mg/kg) and in another 15 patients after intravenous administration of procainamide (15 mg/kg). The results demonstrated that, in the control state acute atrial ER can be significantly demonstrated at each atrial representative site (p＜0.001). The mean ERP400 and ERP600 shortenings were 9±4% and 8±4%, respectively. After procainamide infusion, but not after verapamil, baseline ERP400 and ERP600 values were significantly prolonged at the five representative atrial sites (p＜0.01). Acute atrial ER could still be demonstrated at each atrial site after procainamide or verapamil infusion (p＜0.001). In conclusion, acute atrial ER can be demonstrated after only a 5-minute period of rapid atrial pacing in humans. Intravenous verapamil or procainamide does not abolish this ER process.

關鍵字

抗心律不整藥物 ； 有效不反應期 ； 電氣重塑 ； 快速心房刺激

並列摘要

Atrial electrical remodeling (ER) after spontaneous or pacing-induced atrial fibrillation has been previously described in humans. We investigated atrial ER induced by a 5-minute period of rapid atrial pacing and the pharmacologic effects of verapamil and procainamide on this atrial ER phenomenon. The atrial effective refractory periods (ERPs) at drive cycle lengths of 400 (ERP400) and 600 (ERP600) ms, at five representative atrial sites (high right atrium [HRA]; proximal, middle and distal coronary sinus; interatrial septum), were determined in 20 patients at baseline and immediately after cessation of a 5-minute period of rapid pacing from the HRA at a rate of 150 bpm. The degrees of atrial ERP400 and ERP600 shortening after pacing were calculated as acute atrial ER. The same protocol was repeated in another 15 patients after intravenous administration of verapamil (0.15mg/kg) and in another 15 patients after intravenous administration of procainamide (15 mg/kg). The results demonstrated that, in the control state acute atrial ER can be significantly demonstrated at each atrial representative site (p＜0.001). The mean ERP400 and ERP600 shortenings were 9±4% and 8±4%, respectively. After procainamide infusion, but not after verapamil, baseline ERP400 and ERP600 values were significantly prolonged at the five representative atrial sites (p＜0.01). Acute atrial ER could still be demonstrated at each atrial site after procainamide or verapamil infusion (p＜0.001). In conclusion, acute atrial ER can be demonstrated after only a 5-minute period of rapid atrial pacing in humans. Intravenous verapamil or procainamide does not abolish this ER process.

並列關鍵字

antiarrhythmic agents ； effective refractory period ； electrical remodeling ； rapid atrial pacing