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中华内科杂志 1990年第2期29卷 114-115+129页

作者：吴可光王丽君王之章姜卫国中国医科大学附属第三医院内科中国医科大学附属第三医院病理科

大剂量异搏停长期口服治疗肥厚型心肌病(HCM),从临床症状、左室功能及治疗前后心肌活组织检查的连续观察、探讨异搏停对HCM的影响。资料与方法根据临床检查、ECG、UCG、左心室造影,放射性核素心室显像(ECT)、磁共振及心内膜心肌活组织检... 详细信息

大剂量异搏停长期口服治疗肥厚型心肌病(HCM),从临床症状、左室功能及治疗前后心肌活组织检查的连续观察、探讨异搏停对HCM的影响。资料与方法根据临床检查、ECG、UCG、左心室造影,放射性核素心室显像(ECT)、磁共振及心内膜心肌活组织检查(EMCB)确诊为原发性肥厚型心肌病3例。2例为非梗阻型,1例梗阻型,均为男性。年龄为31、34和49岁。病程2、7及9年。各服异

关键词：投药口服维拉帕米/投药和剂量维拉帕米/治疗应用心肌病肥厚性/病理学心肌病肥厚性/药物疗法人类

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异搏定治疗室性心动过速二例

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中华心血管病杂志 1990年第4期18卷 246-247页

作者：王化南林绍芳娄兹谟周聊生山东省千佛山医院内科

用异搏定治疗某些室性心动过速(室速)已受到关注。我们对2例Q-Tc正常,用异搏定有显效的室速患者做了临床心电生理检查(EPS),报告于下。例1 患者男,15岁。于1986年赛球中突感心慌.某院急诊心率210次/分。用普鲁卡因胺、心得安及升压药无... 详细信息

用异搏定治疗某些室性心动过速(室速)已受到关注。我们对2例Q-Tc正常,用异搏定有显效的室速患者做了临床心电生理检查(EPS),报告于下。例1 患者男,15岁。于1986年赛球中突感心慌.某院急诊心率210次/分。用普鲁卡因胺、心得安及升压药无效,持续9小时后予异搏定5mg静脉注射(静注)中终止。1987年2月又发作,加用利多卡因静注无效,持续达48小时中3次电击复律随即复发,又以异搏定5mg静注终止。转来我院,查体无阳性发现。化验血钾及T、T正常。心电图正常范围,Q-Tc 0.36s。停用异搏定观察至第9日又发作,心电

关键词：病例报告抗心律失常药/治疗应用维拉帕米/治疗应用心动过速室性/药物疗法人类

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异搏停治疗高血压病223例疗效观察

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中华内科杂志 1990年第1期29卷 39-40页

作者：张寿山牛淑贞河北省新河县医院内科

自1986年2月以来,我们试用异搏停(VR)治疗高血压病取得较好效果,对VR的用药方法、剂量、适应范围、疗效及其副作用等进行了临床观察,现报道如下。资料和方法 223例高血压病患者,包括门诊142例,住院81例;男133例,女90例;年龄38～84岁;病... 详细信息

自1986年2月以来,我们试用异搏停(VR)治疗高血压病取得较好效果,对VR的用药方法、剂量、适应范围、疗效及其副作用等进行了临床观察,现报道如下。资料和方法 223例高血压病患者,包括门诊142例,住院81例;男133例,女90例;年龄38～84岁;病史5～30年。均测右臂血压,取3次平均值;

关键词：高血压/药物疗法维拉帕米/治疗应用人类

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Comparison of controlled-onset, extended-release verapamil with amlodipine and amlodipine plus atenolol on exercise performance and ambulatory ischemia in patients with chronic stable angina pectoris

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第4期83卷 507-514页

作者： Frishman, WH Glasser, S Stone, P Deedwania, PC Johnson, M Fakouhi, TD New York Med Coll Dept Med Valhalla NY 10595 USA Univ S Florida Coll Med Div Clin Pharmacol Tampa FL USA Brigham & Womens Hosp Div Cardiovasc Boston MA 02115 USA VA Med Ctr Div Cardiol Fresno CA USA Pharmanet Princeton NJ USA GD Searle & Co Skokie IL 60077 USA

This multicenter, randomized, double-blind, parallel group, placebo lead-in, placebo-controlled study compared the antianginal and anti-ischemic effects of once-daily bedtime dosing of controlled-onset extended-release (COER-24) verapamil to a once-daily morning dosing of amlodipine +/- atenolol in patients with chronic stable angina. A total of 551 patients with exercise-induced myocardial ischemia and evidence of coronary artery disease were randomized to a 4-week, forced-dose titration treatment period with (1) COER-24 verapamil 240 mg titrated to 480 mg at bedtime (n = 173), (2) amlodipine 5 mg titrated to 10 mg/day (n = 149), (3) amlodipine 5 mg (titrated to 10 mg) plus atenolol 50 mg/day in the A.M. (n = 154), or (4) placebo (n = 75), Treadmill exercise tolerance testing (standard Bruce protocol), and 48-hour ambulatory electrocardiographic (Holter) monitoring were performed at the end of placebo lead-in and double-blind treatment. Each active treatment significantly improved symptom-limited exercise duration and time to moderate angina (p less than or equal to 0.01 vs placebo). For patients with baseline ischemia, amlodipine resulted in a statistically significant increase in total duration of ischemic episodes compared with placebo, whereas COER-24 verapamil and amlodipine plus atenolol resulted in statistically significant decreases compared with placebo and amlodipine. Heart rate at onset of ischemic episodes and ST product were also significantly increased with amlodipine (p <0.05) compared with either COER-24 or amlodipine plus atenolol, COER-24 and amlodipine alone or in combination with atenolol improved exercise capacity in patients with angina pectoris, COER-24 verapamil monotherapy or amlodipine plus atenolol combination therapy were more effective than amlodipine monotherapy in decreasing ambulatory myocardial ischemia, especially during the hours of 6 A.M. to 12 noon. (C) 1999 by Excerpta Medica, Inc.

关键词：肾上腺素能β受体拮抗剂/治疗应用氨氯地平/治疗应用心绞痛/药物疗法阿替洛尔/治疗应用钙通道阻滞药/投药和剂量钙通道阻滞药/治疗应用慢性病双盲法药物疗法联合心电描记术便携式运动试验治疗结果维拉帕米/投药和剂量维拉帕米/治疗应用老年人老年人 80以上女(雌)性人类男(雄)性中年人

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EFFECTS OF INTRAVENOUS VERAPAMIL ON CARDIAC-ARRHYTHMIAS AND ON ELECTROCARDIOGRAM

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AMERICAN HEART JOURNAL 1975年第4期90卷 487-498页

作者： HENG, MK SINGH, BN ROCHE, AHG NORRIS, RM MERCER, CJ GREEN LANE HOSP DEPT CARDIOL AUCKLAND NEW ZEALAND GREEN LANE HOSP DEPT CORONARY CARE AUCKLAND NEW ZEALAND AUCKLAND UNIV SCH MED DEPT MED AUCKLAND NEW ZEALAND

The effects of intravenous verapamil on the electrocardiogram in 15 patients with heart disease in sinus rhythm and in 44 patients with supraventricular and ventricular tachyarrhythmias were evaluated. Verapamil prolonged the P-R interval without effect on the QRS duration or the Q-Tc interval. In patients with atrial flutter and fibrillation, A-V block was increased, with slowing of the ventricular rate, in almost all cases but sinus rhythm was restored in only 1 of 12 patients in atrial fibrillation and in 2 of the 11 patients with flutter. Verapamil had no effect in 3 patients with atrial fibrillation complicating WPW syndrome; in 1 of 5 patients with ventricular tachycardia it caused reversion to sinus rhythm. Sinus rhythm was restored promptly by verapamil in 13 of 17 patients with paroxysmal supraventricular tachycardias; in 2 others, sinus rhythm became established 1 to 2 hours after administration of the drug. Transient hypotension, not requiring treatment, was the only side effect noted but not in the patients with supraventricular tachycardias, in whom blood pressure generally increased after reversion to sinus rhythm by verapamil.

关键词：心房颤动/药物疗法心房扑动/药物疗法血压/药物作用心电描记术注射静脉内心动过速/药物疗法维拉帕米/投药和剂量维拉帕米/药理学维拉帕米/治疗应用 Wolff-Parkinson-White综合征/药物疗法青少年成年人老年人儿童儿童学龄前女(雌)性人类男(雄)性中年人

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The effects of anti-hypertensive therapy on the structural, mechanical and metabolic properties of the rat aorta

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JOURNAL OF MUSCLE RESEARCH AND CELL MOTILITY 2000年第3期21卷 255-267页

作者： Clark, JF Radda, GK Boehm, EA Univ Oxford Dept Biochem Oxford OX1 3QU England

The vascular system exhibits altered growth, calcium responses and metabolism during hypertension. To relate such changes, we compared histological, tension and metabolic responses in the aorta from 32-week-old spontaneously hypertensive rats (SHRs), normotensive Wistar-Kyoto (WKY) rats, and SHRs treated with Verapamil (V) and ACE-inhibitor, Trandolapril (T) as well as a combination of the two treatments (C). Vascular hypertrophy was apparent in the SHRs. Contractile responses induced by 50 mmol/l KCl and 2.5 mmol/l Ca2+ were significantly lower in the SHR (64.4 mN/mm(2) vs. 49.2 mN/mm(2)), but an associated increase in Ca2+-sensitivity (EC50 of extracellular Ca2+ (mu mol/l): SHR, 456 vs. WKY, 616) normalised tension generating ability. All treatments led to significant decreases in blood pressure, although only T and C treated animals became normotensive with concomitant normalisation of vascular hypertrophy. An increase in oxygen consumption was apparent in the SHR aorta, which was associated with significant differences in the activities of key metabolic enzymes. Anti-hypertensive treatment normalised many of the metabolic parameters, with the C therapy being the most efficacious. We conclude that the treatment of hypertension by combined therapy leads to a better normalisation of structural, contractile, and metabolic parameters in the SHR, than either treatment alone and that metabolic changes with the pathology are resolved with appropriate therapy.

关键词：血管紧张素转换酶抑制药/药理学血管紧张素转换酶抑制药/治疗应用抗高血压药/药理学抗高血压药/治疗应用主动脉/药物作用主动脉/代谢主动脉/病理生理学高血压/药物疗法高血压/代谢高血压/病理生理学吲哚类/药理学吲哚类/治疗应用肌收缩/药物作用肌平滑血管/药物作用肌平滑血管/代谢肌平滑血管/病理生理学大鼠近交SHR 大鼠近交WKY 血管舒张药/药理学血管舒张药/治疗应用维拉帕米/药理学维拉帕米/治疗应用动物男(雄)性大鼠

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Demonstration of diastolic and presystolic Purkinje potentials as critical potentials in a macroreentry circuit of verapamil-sensitive idiopathic left ventricular tachycardia

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第3期36卷 811-823页

作者： Nogami, A Naito, S Tada, H Taniguchi, K Okamoto, Y Nishimura, S Yamauchi, Y Aonuma, K Goya, M Iesaka, Y Hiroe, M Yokohama Rosai Hosp Div Cardiol Kohoku Ku Yokohama Kanagawa 2220036 Japan Gunma Prefectural Cardiovasc Ctr Div Cardiol Maebashi Gumma Japan Yokosuka Kyosai Gen Hosp Div Cardiol Yokosuka Kanagawa Japan Tsuchiura Kyodo Gen Hosp Cardiovasc Ctr Tsuchiura Ibaraki Japan Tokyo Med & Dent Univ Dept Med 2 Tokyo Japan

OBJECTIVES The purpose of this study was to determine the relation of diastolic and presystolic potentials recorded during verapamil-sensitive idiopathic left ventricular tachycardia (ILVT) to reentry circuit. BACKGROUNDS Successful ablation of verapamil-sensitive ILVT at the zone of slow conduction from which the diastolic potential is recorded has been reported. However, the relationship between the diastolic potential and the reentrant circuit remains a matter of debate. METHODS Radiofrequency (RF) ablation was performed in 20 patients with verapamil-sensitive ILVT. After identifying the ventricular tachycardia (VT) exit site, we searched for the mid-diastolic potential(P1) during VT. Entrainment followed by RF current application was performed. Ii the mid-diastolic potential could not be detected, RF current was applied at the VT exit site showing the earliest ventricular activation with a single fused presystolic Purkinje potential (P2). RESULTS In 15 of 20 patients, both P1 and P2 were recorded during VT from midseptal region. Entrainment pacing captured P1 orthodromically and reset the VT. The interval from stimulus to P1 was prolonged as the pacing rate was increased. Radiofrequency ablation was successfully performed at this site in all 15 patients. After successful ablation, P1 appeared after the QRS complex during sinus rhythm with the identical sequence to that during VT. In the remaining five patients, the diastolic potential could not be detected, and a single fused P2 was recorded only at the VT exit site. Successful ablation was performed at this site in all five patients. CONCLUSIONS This study demonstrates that P1 and P2 are critical potentials in a circuit of verapamil-sensitive ILVT and suggests the presence of a macroreentry circuit involving the normal Purkinje system and the abnormal Purkinje tissue with decremental property and verapamil-sensitivity, (C) 2000 by the American College of Cardiology.

关键词：抗心律失常药/治疗应用导管消融术心舒期心电描记术电生理学心内膜/病理生理学手术后期间浦肯野纤维/病理生理学心缩期心动过速室性/药物疗法心动过速室性/病理生理学心动过速室性/外科学心室功能左/药物作用维拉帕米/治疗应用青少年成年人老年人儿童女(雌)性人类男(雄)性中年人

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Prognostic implications of ambulatory myocardial ischemia and arrhythmias and relations to ischemia on exercise in chronic stable angina pectoris (the Angina Prognosis Study in Stockholm [APSIS])

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第10期84卷 1151-1157页

作者： Forslund, L Hjemdahl, P Held, C Eriksson, SV Björkander, I Rehnqvist, N Danderyd Hosp Dept Med Stockholm Sweden Karolinska Hosp Dept Clin Pharmacol S-10401 Stockholm Sweden Natl Board Hlth & Welf Stockholm Sweden

The prognostic significance of ambulatory ischemia, alone and in relation to ischemia during exercise was assessed in 686 patients (475 men) with chronic stable angina pectoris taking part in the Angina Prognosis Study In Stockholm (APSIS), who had 24-hour ambulatory electrocardiographic registrations and exercise tests at baseline (n = 678) and after 1 month (n = 607) of double-blind treatment with metoprolol or verapamil. Ambulatory electrocardiograms were analyzed for ventricular premature complexes and ST-segment depression. During a median follow-vp of 40 months, 29 patients died of cardiovascular (CV) causes, 27 had a nonfatal myocardial infarction, and 89 underwent revascularization. Patients with CV death had more episodes (median 5 vs 1;p < 0.01) and longer median duration (24 vs 3 minutes;p < 0.01) of ST-segment depression than patients without events. For those who had undergone revascularization, the duration was also longer (12 vs 3 minutes;p < 0.05). In a multivariate Cox model including sex, history of previous myocardial infarction, hypertension, and diabetes, the duration of ST-segment depression independently predicted CV death. When exercise testing was included, ambulatory ischemia carried additional prognostic information only among patients with ST-segment depression greater than or equal to 2 mm during exercise. When the treatment given and treatment effects on ambulatory ischemia were added to the Cox model, no significant impact on prognosis was found. Ventricular premature complexes carried no prognostic information. Thus, in patients with stable angina pectoris, ischemia during ambulatory monitoring showed independent prognostic importance regarding CV death. Ambulatory electrocardiographic monitoring and exercise testing provide complementary information, but only among patients with marked ischemia during exercise. Treatment reduced ambulatory ischemia, but the short-term treatment effects did not significantly influence prognosis. (C) 1

关键词：肾上腺素能β受体拮抗剂/治疗应用心绞痛/药物疗法心绞痛/死亡率钙通道阻滞药/治疗应用慢性病心电描记术便携式运动试验美托洛尔/治疗应用心肌缺血/诊断预后存活率分析维拉帕米/治疗应用老年人女(雌)性人类男(雄)性中年人

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Long-term effects of diltiazem and verapamil on mortality and cardiac events in non-Q-wave acute myocardial infarction without pulmonary congestion:: Post hoc subset analysis of the multicenter diltiazem postinfarction trial and the Second Danish Verapamil Trial studies

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第3期86卷 275-279页

作者： Gibson, RS Hansen, JF Messerli, F Schechtman, KB Boden, WE Univ Virginia Med Ctr Dept Internal Med Charlottesville VA 22908 USA Bispebjerg Hosp DK-2400 Copenhagen NV Denmark Tulane Univ New Orleans LA 70118 USA Washington Univ St Louis MO USA Dept Vet Affairs Med Ctr Syracuse NY USA

The main objective of this retrospective analysis was to evaluate the long-term effect of the heart rate-lowering calcium antagonists verapamil and diltiazem on the incidence of combined cardiac events and all-cause mortality in patients who had experienced a non-Q-wave acute myocardial infarction (AMI), but who did not also have pulmonary congestion. In addition, factors having an independent association with these 2 outcomes were identified. Of 817 non-Q-wave patients, 81 (9.9%) died during 12 to 52 months of follow-up. The unadjusted mortality rate was 42% lower in patients randomized to calcium antagonist therapy than placebo (7.2% vs 12.4%, p = 0.010). Non-Q-wave patients who died during follow-up were older than patients who survived (62 vs 58 years, p = 0.001). Other factors found to have an independent association with all-cause mortality included diuretic use (RR 2.79), diabetes mellitus (RR 2.86), and New York Heart Association class >1 (RR 1.73). The covariate adjusted all-cause mortality risk ratio associated with randomization to calcium antagonist therapy was 0.65 (95% confidence interval [0.40 to 1.05, p = 0.079]). Overall, 153 patients (18.7%) died or had nonfatal reinfarction. The unadjusted combined event rate was 31% lower in patients randomized to calcium antagonist therapy than to placebo (15.2% vs 21.9%, p <0.006), Factors found to have an independent association with cardiac events included age, diabetes (RR 2.82), diuretic use (RR 2.04), and previous AMI (RR 1.71). In addition, randomization to the calcium antagonist group had a significant independent association with reduced cardiac events (p = 0.031). The cavariate adjusted event rate RR associated with randomization to the calcium antagonist group was 0.69 (95% confidence interval [0.49 to 0.97]). In conclusion, the heart rate-lowering calcium antagonists diltiazem and verapamil may play an important role in reducing long-term mortality and reinfarction in non-Q-wave AMI without pulmonary

关键词：钙通道阻滞药/治疗应用丹麦地尔硫|艹卓|/治疗应用心电描记术/药物作用随访研究心肌梗死/药物疗法心肌梗死/死亡率肺水肿/药物疗法肺水肿/死亡率回顾性研究维拉帕米/治疗应用成年人老年人女(雌)性人类男(雄)性中年人

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Cost-effective management of acute atrial fibrillation: Role of rate control, spontaneous conversion, medical and direct current cardioversion, transesophageal echocardiography, and antiembolic therapy

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第10A期85卷 36D-45D页

作者： Naccarelli, GV Dell'Orfano, JT Wolbrette, DL Patel, HM Luck, JC Penn State Univ Coll Med Div Cardiol Milton S Hershey Med Ctr Hershey PA 17033 USA

Management strategies for the acute treatment of atrial fibrillation (AF) include: (1) the use of intravenous drugs for rate control, (2) drug termination, or (3) direct current (DC) cardioversion. Delays in cardioversion can promote atrial remodeling and add thromboembolic risk. Rate control awaiting spontaneous or pharmacologic conversion may be a cost-effective strategy in patients presenting with recent onset of symptoms. Early DC cardioversion con be cost-effective and minimize antiembolic therapy issues in the acute setting, In patients presenting with AF of unknown or >48 hours' duration, rate control and therapeutic warfarin for 3-4 weeks followed by medical or DC cardioversion is standard practice, However, delays in conversion promote atrial remodeling that makes restoration of sinus rhythm more difficult and increases the likelihood of postcardioversion AF recurrence. Transesophageal echocardiography can identify patients at low risk for a cardioversion-related embolic event and allows cardioversion to be performed earlier, thereby minimizing atrial remodeling. (C) 2000 by Excerpta Medico, Inc.

关键词：算法胺碘酮/治疗应用抗心律失常药/治疗应用心房颤动/药物疗法心房颤动/经济学心房颤动/外科学心房颤动/治疗心房扑动/药物疗法费用效益分析超声心动描记术经食管电抗休克氟卡尼/治疗应用普鲁卡因胺/治疗应用普罗帕酮/治疗应用奎尼丁/治疗应用索他洛尔/治疗应用维拉帕米/治疗应用人类

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