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要旨 徐脈性慢性心房細動20例にcilostazolを使用し,頻脈化効果を検討した.未治療例(A群)14例,少量carteolol療法中の軽度徐脈残存例(B群)6例に対し,cilostazol 100mg/日を使用し,ホルター心電図により評価した.cilostazolによりA群の最大R-R間隔は3.4±0.7秒から2.8±0.4秒に短縮(p<0.05),RR間隔が2秒以上のpause eventも1,407±1,656回/日より272±221回/日に滅少(p<0.001)した.1日平均心拍数が79,1±10/分であったB群では有意な変化を認めなかった.個々の症例で検討すると,高度な徐脈例では頻脈効果が高かったが,徐脈が軽度の例では無効例が多かった.心房細動の徐脈に対する薬物療法として確立されたものはなく,cilostazolは抗血小板薬としての効果のみならず頻脈化作用も期待され,今後,徐脈改善薬として臨床応用される可能性を示した.
The purpose of this study is the evaluation of positivechronotropic effect of cilostazol in patients with chronicasymptomatic bradycardic atrial fibrillation. Weexamined in twenty patients comprising 14 patientswithout heart rate control treatment (group A) and 6patients with low-dose carteolol therapy (group B). 24hour ambulatory Holter ECG was performed before andafter administration of cilostazol. Cilostazol dosage was50mg twice daily. During this study we find no severeadverse effect of cilostazol except for mild headache in1 patient.
After administration of cilostazol to group A, maximum R-R interval shortened (p<0.05), amount of pauseevent decreased (p<0.001), minimum HR increased(p <0.01) increased. Maximum HR and mean HR didnot show remarkable change. In group B, these allparameters by 24-hour Holter ECG did not showremarkable change, but 2 patients of group B showedmild improvement of these parameters. In detailedinvestigation of cilostazol effect, shortening of maximum R-R interval and decrease of pause event weremore prominent in patients with longer maximum Rintervals and more pause event. In group B, all BolterECG parameters did not improved, but we could findweak chronotropic effect of cilostazol in 2 patients ofgroup B. This result revealed the hypothesis that themechanism of chronotropic effect of cilostazol was notonly beta-adrenergic stimulation but also other unknown mechanism. In conclusion, cilostazol had abeneficial positive chronotropic effect in patients withbradycardic atrial fibrillation.
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