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Kokyu to Junkan Volume 49, Issue 2 （February 2001）

呼吸と循環 49巻2号（2001年2月発行）

Japanese English

研究

慢性心房細動頻脈に対するcarteolol少量療法頻脈の予防と夜間徐脈の改善 Low-dose Carteolol Therapy for Chronic Atrial Fibrillation: reducing tachycardia and improving nocturnal bradycardia 近藤信介 ¹ , 李光浩 ¹ , 鹿間毅 ¹ , 寺田智信 ² , 入江由紀子 ² , 斉藤道彦 ² , 石渡葉子 ² , 片岡重夫 ² Nobusuke Kondou ¹ , Koukou Ri ¹ , Takeshi Shikama ¹ , Tomonobu Terada ² , Yukiko Irie ² , Michihiko Saitou ² , Youko Ishiwatari ² , Shigeo Kataoka ² ¹公立長生病院内科 ²公立長生病院生理検査部 ¹Chousei Municipal Hospital, Division of Internal Meidcine ²Chousei Municipal Hospital, Division of Physiological Laboratory キーワード：慢性心房細動 , 心拍数調節 , carteolol少量療法 , chronic atrial fibrillation , heart rate control , low-dose carteolol Keyword: 慢性心房細動 , 心拍数調節 , carteolol少量療法 , chronic atrial fibrillation , heart rate control , low-dose carteolol pp.191-196

発行日 2001年2月15日 Published Date 2001/2/15

DOI https://doi.org/10.11477/mf.1404902245

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Abstract 文献概要
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　慢性心房細動18例に対しcarteolol少量とジギタリス製剤を用い，いずれが良好な心拍数調節を得やすいか比較検討した．頻脈の抑制効果はcarteolol 2mg/dayで十分な発現を認め，心拍数調節に必要なcarteololの量は，高血圧症，虚血性心疾患に対する用量とは異なる可能性を認めた．頻脈治療時に問題となる夜間徐脈の出現はcarteolol少量療法では認められず，未治療時と比較しても夜間徐脈を改善する効果が認められた．ジギタリス製剤と比較すると，carteolol少量療法は頻脈の抑制効果は有意に優れていた．さらに，ジギタリス製剤では夜間徐脈化するのに反し，夜間の徐脈を改善し，容易に良好な心拍数調節が得られ，第一選択薬として使用し得る可能性が示された．頻脈の指標として，Short R-R index（R-R間隔0.5秒以下のbeat数/総心拍数）を用いると，Short R-R beat数を定量的に把握可能で，治療効果判定に有用であった．

　The purpose of this study is to compare the effects of low-dose carteolol and digoxin on heart-rate control in18 patients with chronic atrial fibrillation. Firstly, in 9patients without heart rate control treatment, 24-hourheart rate profiles were studied before (control) and 2weeks after low-dose carteolol treatment (1 mg twicedaily), using 24-hour ambulatory Bolter ECG. Secondly,9 patients under conventional digoxin treatment for thepurpose of heart rate control were studied in the samemanner. We switched the conventional digoxin therapyto low-dose carteolol (1mg twice daily) therapy and 24-hour ambulatory Holter ECG was performed againafter two or four weeks.

　Compared with the controls, low-dose carteolol therapy improved mean HR (p＜0.01). maximum HR (p＜0.0001), maximum R-R interval (p＜0.05) and pauseevent (p＜0.05) (Table 1, Fig. 2, 3). Minimum HR increased slightly, but it was not significant. Comparedwith conventional digoxin treatment, low-dose carteolol therapy improved minimum HR (p＜0.01), maximum HR (p＜0.0005), maximum R-R interval (p＜0.05)and pause event (p＜0.05) (Table 2, Fig 3, 4). Althoughthere was no significant difference of mean HR betweenthese two treatments, low-dose carteolol therapyreduced tachycardia and improved nocturnal bradycardia compared with controls and conventional digoxintreatment.

　An irregular sequence of R-R intervals producesadverse hemodynamic consequences. One of the important purposes of heart rate control is reduction of excessamount of short R-R intervals. Since it was difficult toevaluate short R-R interval frequency by conventionalparameters, we created an original parameter, “Short R-R index”.

　(Number of heart beats less than 0.5-sec.)/(Totalheart beats) (%). Using this parameter, we found thatlow-dose carteolol therapy is highly effective in patientswith many short R-R beats (Fig. 2). Furthermore, low-dose carteolol was better than digoxin in reducing theshort R-R beat number (Fig 4).

　We concluded that low-dose carteolol therapy is moreeffective than conventional digoxin treatment on theheart rate control of patients with chronic atrial fibrillation.