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[Pathophysiological analysis and treatment of arrhythmias, using Holter electrocardiography]
T Nakanishi1, H Takahashi, M Yoshimura
1Department of Clinical Laboratory and Medicine, Kyoto Prefectural University of Medicine.
Insights
Enhanced catecholamine activity contributes to ventricular premature systoles (VPS) in patients without heart disease. Treatment strategies for VPS vary based on coupling intervals and underlying sympathetic tone, with amiodarone showing broad efficacy.
Area of Science:
- Cardiology
- Pharmacology
Context:
- Ventricular premature systoles (VPS) can occur in patients without apparent heart disease.
- Endogenous catecholamine activity is implicated in the pathogenesis of VPS.
Purpose:
- To investigate factors influencing VPS occurrence and severity.
- To evaluate antiarrhythmic drug efficacy for VPS treatment.
Summary:
- A study correlated urinary norepinephrine excretion with VPS severity, suggesting catecholamine involvement.
- Beta-blockers were effective in patients with high catecholamine levels.
- Antiarrhythmic drugs (Class IA, IB, II, III, IV) were assessed in 110 patients with frequent VPS.
- Treatment recommendations were made based on VPS coupling intervals and drug kinetics.
- Amiodarone (Class III) demonstrated the highest potency, while verapamil (Class IV) showed efficacy in elderly patients.
Impact:
- Provides insights into the role of catecholamines in non-cardiac VPS.
- Offers evidence-based guidance for selecting antiarrhythmic therapies for VPS.
- Highlights amiodarone as a potent option for various VPS types.
Abstract:
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.