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Kokyu to Junkan Volume 37, Issue 6 （June 1989）

呼吸と循環 37巻6号（1989年6月発行）

Japanese English

研究

Mexiletineのatrial vulnerabilityに及ぼす効果 Effect of mexiletine on human atrial vulnerability 大森斎 ¹ , 井上大介 ¹ , 白山武司 ¹ , 東秋弘 ¹ , 杉原洋樹 ¹ , 古川啓三 ¹ , 朝山純 ¹ , 勝目紘 ¹ , 中川雅夫 ¹ Itsuki Omori ¹ , Daisuke Inoue ¹ , Takeshi Shirayama ¹ , Akihiro Azuma ¹ , Hiroki Sugihara ¹ , Keizo Furukawa ¹ , Jun Asayama ¹ , Hiroshi Katsume ¹ , Masao Nakagawa ¹ ¹京都府立医科大学策二内科 ¹Second Department of Medicine, Kyoto Prefectural University of Medicine pp.663-667

発行日 1989年6月15日 Published Date 1989/6/15

DOI https://doi.org/10.11477/mf.1404205495

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Abstract 文献概要
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　MexiletineはVaughan Williams分類のIb群に属する抗不整脈剤で，心室性不整脈に対する有効性が従来より報告されてきた。一方，心房性不整脈に対しては一般にIb群抗不整脈剤は無効であるとされるため，mexiletineのatrial vulnerabilityに対する臨床電気生理学的検討はほとんど行われていない。また，心房性不整脈の有効例が報告されているものの，その作用機序についてはなお不明の点が多い。今回，我々はmexile-tineのatrial vulnerabilityに及ぼす影響を検討したので報告する。

The effect of mexiletine on human atrial vulnera-bility was investigated in 14 subjects (8 with paroxysmal atrial fibrillation, 2 with paroxysmal atrial tachycardia, 2 with ventricular tachycardia, 1 with sick sinus syndrome and 1 with Wolff-Parkinson-White syndrome).

During the electrophysiologic study, after 8 consecutive stimuli (A₁) were delivered through theelectorode catheter positioned at high right atrium, premature stimulus (A₂) was introduced, and follo-wing measurements were made ; 1) Aw : atrial activity width of A₁, 2) maximum atrial fragmenta-tion (MAF) : the longest atrial activity width of A₁, which was expressed by the relative value against Aw, 3) fragmented atrial activity zone (FAZ) : the zone of the coupling interval (A₁A₂) with the prolongation of the atrial activity width at A₂ more than 150% against Aw, 4) conduction delay zone (CDZ) : the zone of A₁A₂ with the prolongation more than 20 msec of the intraatrial conduction time at A₂ from high right atrium to coronary sinus or low right atrium against the intraatrial conduction time at A₁, and 5) right atrial effective refractory period (RAERP). These measurements were repeated after the intravenous administration of mexiletine (2 mg/kg/10 min).

3 cases (case 12, 13 and 14), whose FAZ and CDZ were 0 msec, were excluded from the following evaluation. Mexiletine showed little effect on Aw and RAERP, but singnificantly shortened MAF and FAZ (p<0. 001 and p<0.05, respectively). CDZ were also reduced in 3 cases and remained unchan-ged in 6 cases, though no statistical difference of CDZ was recognized between before and after the administration of mexiletine.

We conclude that mexiletine could reduce human atrial vulnerability, and that the mechanism of this reduction might be owing to the improved intraatrial conduction delay by mexiletine.