RU2070038C1 - Method of estimation of individual effectiveness of antiarrhythmic preparation - Google Patents

Abstract

FIELD: medicine, cardiology. SUBSTANCE: ectopic myocardium activity is provoked by dobutamine administration before and at peak effect of antiarrhythmic preparation. Preparation is considered to be effective if dobutamine at the same dose does not cause arrhythmia in combination with preparation studied. EFFECT: improved method of estimation.

Description

 The invention relates to medicine, in particular to cardiology, and can be used to individually assess the effectiveness of an antiarrhythmic drug.

 There is a method of evaluating the individual effectiveness of an antiarrhythmic drug, which uses discrete administration of isoprenaline to control the reproduction of ventricular tachyarrhythmia in a patient before and at the maximum effect of the antiarrhythmic drug. At the same time, the drug is considered effective, at the expected maximum action of which the arrhythmia was not reproduced. (Bobrov V. A. Mitchenko E, I. Frolova A. I. Simorot V. N. Method for assessing the individual effectiveness of an antiarrhythmic drug. Auth. St. USSR No 1586674, A 61 / B 5/00, 1990).

 However, the use of isoprepaline has the following disadvantages. With the introduction of isoprepaline, a significant increase in sinus rhythm is observed, which suppresses the ectopic activity of the ventricles and does not allow to identify the focus of arrhythmia. Isoprenaline, increasing the myocardial oxygen demand without increasing coronary blood flow, in patients with coronary heart disease can lead to an exacerbation of the disease, including an attack of angina pectoris or myocardial infarction, the action of isoprenaline stops 30 to 40 minutes after the end of administration, which can lead to long provoked ventricular arrhythmias, as well as instability of the hemodynamics of the patient. Isoprenaline is a stimulant of both beta-1 and beta-2-adrenergic receptors, with stimulation of which pronounced vasodilation and a decrease in blood pressure are observed, even without the occurrence of ectopic activity of the myocardium, which leads to a violation of the hemodynamics of the patient. Isoprenaline can increase the content of glucose and lactic acid in the blood, which limits its use in patients with diabetes mellitus.

 The proposed method is free from these disadvantages, since with the introduction of dobutamine by titration, it is possible to activate the ectopic focus in the myocardium without increasing the sinus rhythm. Dobutamine does not upset the balance in the process of “myocardial oxygen demand for oxygen delivery” and is used both for angina pectoris and in the acute period of a heart attack. The action of dobutamine is terminated 3 minutes after the end of administration. Dobutamine is a selective beta-1 adrenostimulator and affects only receptors located in the ventricular myocardium. Dobutamine does not increase blood glucose, which allows it to be used in patients with diabetes mellitus.

 The aim of the invention is to increase the safety and information content of the method, as well as the expansion of the contingent of the examined patients.

 This goal is achieved by the fact that the ectopic activity of the ventricular myocardium is caused by double intravenous administration of dobutamine in equal doses before and at the maximum action of the antiarrhythmic drug, and that drug is considered effective, at the maximum action of which arrhythmia does not occur.

 The method is as follows: a patient under the control of ECG and blood pressure is injected intravenously, with the help of titration dobutamine 250 mg in 250 ml of 5-glucose until the ectopic activity of the myocardium at a rate of no higher than 10 μg / kg / min. In case of ventricular arrhythmia provocation, dobutamine administration is stopped and an antiarrhythmic drug is administered intravenously: metoprolol 0.2 mg / kg body weight, amiodarone 5 mg / kg, rhythmylene 2 mg / kg body weight, obzidan 1 mg, ethmosin 150 mg. Then, at the expected maximum effect of the antiarrhythmic drug, dobutamine is re-administered in the same dose. An antiarrhythmic drug, at the expected maximum action of which it is not possible to provoke ectopic activity of the ventricular myocardium, is considered effective. In the absence of effectiveness, the test is repeated with another antiarrhythmic drug after a time due to 3 5 half-lives of the previously introduced antiarrhythmic drug.

 Considering that dobutamine does not cause an increase in myocardial oxygen demand, increases coronary blood flow, does not cause a decrease in pressure, does not exceed the content of glucose and lactic acid in the blood, this makes it possible to expand the contingent of the examined patients.

 The method has clear advantages compared with the prototype, since with the introduction of dobutamine by the titration method, it is possible to activate the ectopic focus in the myocardium without increasing the sinus rhythm. Dobutamine does not upset the balance during oxygen consumption by the myocardium and is a selective beta-1-adrenostimulator that affects only ventricular myocardial receptors. The action of dobutamine is terminated 3 minutes after the end of administration. Dobutamine does not increase blood glucose, which allows it to be used in patients with diabetes mellitus. Dobutamine can be used both for angina pectoris and in the acute period of myocardial infarction.

 The method is illustrated by the following clinical examples.

 Example 1. Patient R. 47 years old, diagnosis: myocarditis cardiosclerosis, ventricular parasystole, ventricular extrasystole. Periods of accelerated idioventricular rhythm of NPOs.

 In the selection of antiarrhythmic therapy, sinus tachycardia was observed during a test with dosed physical activity and an isoprenaline test (140 150 in 1 min), which suppressed the proposed method: dobutamine was administered dropwise intravenously under an ECG and blood pressure monitoring before ectopic activity ventricular myocardium (frequent ventricular extrasystole, accelerated idioventricular rhythm). After the administration of rhythmylene 150 mg intravenously, with the introduction of dobutamine in the same dose, it was not possible to provoke ectopic activity of the myocardium. The patient was discharged in satisfactory condition after a 10-day course of treatment with rhythmylene. Extrasystole was not observed.

Example 2. Patient D. 50 years old, diagnosis: myocarditis cardiosclerosis, ventricular extrasystole NK _o , diabetes mellitus of moderate severity. The patient carried out the proposed method: in a horizontal position under the control of an ECG and blood pressure, dobutamine was injected intravenously by titration until the ectopic activity of the myocardium occurred, ventricular extrasystology was caused by the type of bigimenia. After administration of ethmosin 150 mg by repeated administration of dobutamine, ectopic activity was not possible to provoke. After course administration of ethmosin for 2 weeks, the patient was discharged in satisfactory condition, ventricular extrasystole was not observed.

Claims (1)

 A method for assessing the individual effectiveness of an antiarrhythmic drug in patients with ventricular arrhythmias without concomitant hypertension by provoking ectopic activity of the ventricular myocardium under ECG control, characterized in that they administer twice the same dose of dobutamine at a rate of not more than 10 μg / kg / min to and at the maximum the action of the antiarrhythmic drug, while the antiarrhythmic drug, at the maximum action of which ectopic activity is not provoked, consider the effect an apparent.