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Attenuation of Provoked Left Ventricular Pressure Gradient by Class Ia Antiarrhythmic Drugs in Two Patients with Hypertrophic Obstructive Cardiomyopathy Norihide Takaya 1 , Yuji Nakazato 1 , Atushi Yamada 1 , Satoshi Sunayama 1 , Yoshirou Watanabe 1 , Masataka Sumiyoshi 1 , Hiroyuki Daida 1 , Hidehiko Sakurai 1 , Hiroshi Yamaguchi 1 1Division of Cardiology, Department of Internal Medicine, Juntendo University School of Medicine Keyword: 労作時失神 , Ia群抗不整脈薬 , 左室流出路圧較差 , syncope on exertion , class Ia antiarrhythmic drug , left ventricular outflow tract pressure gradient pp.1167-1171
Published Date 1999/11/15
DOI https://doi.org/10.11477/mf.1404902001
  • Abstract
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 Two male patients, aged 43 and 36 respectively had suffered from syncope and dizziness on exertion. Under the diagnosis of hypertrophic obstructive cardiomyopathy (HOCM) by echocardiogram, a study of cardiac catheterization was made. Left ventricular pressure gradients at the base line state were less than 30 mmHg in both cases. After provocation with isoproterenol infusion, atrial pacing or post ventricular extrasystolic potentiation increased the maximum pressure gradient by more than 130 mmHg. The intravenous administration of disopyramide and cibenzoline in each patient respectively during catheterization abolished the provoked pressure gradient. Therefore, oral disopyramide combined with propranolol was given to the first patient and oral cibenzoline was given to the second patient. These treatments were effective and resulted in the improvement of clinical symptoms.

 In HOCM, some patients despite showing a mild pressure gradient at the baseline state show severe symptoms like syncope particularly on exertion. For such patients a provocative test to induce a ventricular pressure gradient across the outflow tract seems to be useful. Class Ia antiarrhythmic drugs including cibenzoline were effective in preventing syncope by the attenuation of the provoked outflow tract pressure gradient.


Copyright © 1999, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1200 印刷版ISSN 0452-3458 医学書院

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