[Pathophysiological analysis and treatment of arrhythmias, using Holter electrocardiography].
Using Holter electrocardiography, the primary factors affecting the occurrence and severity of ventricular premature systoles (VPS) and the method of treatment of VPS in patients having no apparent heart disease were examined. Pathological significance of catecholamines on the occurrence of VPS was studied in 182 patients. The close correlation between the severity of VPS and the total amount of urinary norepinephrine excretion demonstrated in this study suggests that the occurrence of VPS in patients with no apparent underlying heart disease, especially those over 40 years of age, may be mediated by enhanced endogenous catecholamine activities. This assumption is further substantiated by the fact that beta adrenoceptor blockade was effective against VPS in patients excreting high amounts of catecholamines, but not in patients with normal catecholamine excretion. Antiarrhythmic efficacy of class IA (disopyramide), IB (aprindine, mexiletine), II (propranolol), III (amiodarone) and IV (verapamil) drug was studied in 110 patients having more than 1,000 VPS per day. Judging from these results, we may conclude that: 1) VPS with short coupling intervals should be treated with class I drugs such as mexiletine which have a fast kinetics of unbinding from the inactivated state, 2) VPS with intermediate or long coupling intervals should be treated with class I drugs such as disopyramide and aprindine, which have a slow kinetics of unbinding from the inactivated state, 3) class II drug, propranolol, was effective against VPS associated with an increased sympathetic tone, 4) class III drug, amiodarone, was the most potent antiarrhythmic agent against any type of VPS, and 5) class IV drug, verapamil, appeared effective against VPS in elderly patients.
Department of Clinical Laboratory and Medicine, Kyoto Prefectural University of Medicine.
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Nakanishi
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Takahashi
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Yoshimura
D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D005117:Cardiac Complexes, Premature / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000652:urine; D013564:Sympathetic Nervous System / Q000503:physiopathology
D000889:Anti-Arrhythmia Agents; D009638:Norepinephrine