Method of assessment the individual effectiveness of antiarrhythmic drug

 

(57) Abstract:

The invention relates to medicine, cardiology. Essence: ectopic activity of the myocardium provoke the introduction of dobutamine before and at the peak of the antiarrhythmic effect of the drug. Effective consider the drug, against which the arrhythmia by dobutamine infusion at the same dose is not called.

The invention relates to medicine, particularly cardiology, and can be used for individual assessment of the effectiveness of antiarrhythmic drug.

There is a method of assessing the individual effectiveness of antiarrhythmic drug, which uses a discrete introduction of izoprenalin to the controlled playback of ventricular tachyarrhythmias in a patient before and at the peak of action antiarrhythmic drug. An effective consider the drug on the expected maximum which the arrhythmia is not played. (Beavers Century A. Mitchenko, I. Frolov A. I. Simonot Century. N. Method of assessment the individual effectiveness of antiarrhythmic drug. Auth.St. USSR N 1586674, A 61/B 5/00, 1990).

However, the application of isoprenaline has the following disadvantages. With the introduction of isoprenaline significant writei. Izoprenalin, increasing the need of oxygen without increasing coronary blood flow in patients with coronary heart disease can lead to exacerbation of the disease, including the cause angina, or myocardial infarction, the effect of izoprenalin stops after 30 to 40 min after injection, which can spend to long provoked ventricular arrhythmias and hemodynamic instability of the patient. Izoprenalin is a stimulator of both beta-1 and beta-2-adrenergic receptors, the stimulation of which there is a pronounced vasodilatation and lower blood pressure, even without the occurrence of ectopic activity of the myocardium, which leads to disruption of the hemodynamics of the patient. Izoprenalin can improve glucose and lactic acid in the blood, which limits its use in patients with diabetes mellitus.

The proposed method is free of the above disadvantages, since the introduction of dobutamine titration method can achieve activation of ectopic lesion in the myocardium without frequent sinus rhythm. Dobutamine does not violate the balance in the process "requirement of a myocardium in oxygen delivery oxygen and is used as angina, cumin is a selective beta-1-adrainostimulatoram and only affects the receptors, located in the myocardium of the ventricles. Dobutamine does not increase the glucose content in the blood, it can be used in patients with diabetes mellitus.

The aim of the invention is to increase security and informative way, as well as the expansion of contingent examined patients.

This goal is achieved by the fact that ectopic activity of the myocardium of the ventricles is called twice intravenous dobutamine in the same doses up to and at the maximum effect of anti-arrhythmic drug, and the drug is considered effective to the maximum of the action which the arrhythmia does not occur.

The method is as follows: the patient under the supervision of the ECG and HELL is injected intravenously, the method of the pit dobutamine 250 mg in 250 ml 5-Noah glucose to the occurrence of ectopic activity of the myocardium at a rate not higher than 10 g/kg/min In case of inducing ventricular fibrillation introduction of dobutamine stop and intravenous antiarrhythmic drug: metoprolol 0.2 mg/kg of body weight, amiodarone 5 mg/kg, ritilin 2 mg/kg of body weight, obzidan 1 mg, etmozin 150 mg Then the expected maximum effect of anti-arrhythmic drug is re-administered dobutamine in the same dose. Antiaritmicheskogo fails, it is considered effective. In the absence of the efficiency test is repeated with another antiarrhythmic drug over time due to 3 5 elimination half-life previously introduced anti-arrhythmic drug.

Given that dobutamine does not cause increased demand of oxygen, increases coronary blood flow does not cause pressure reduction does not exceed the content of glucose and lactic acid in the blood, it gives the possibility to enlarge the pool of examined patients.

The method has clear advantages in comparison with the prototype, since the introduction of dobutamine titration method can achieve activation of ectopic lesion in the myocardium without frequent sinus rhythm. Dobutamine does not violate the balance in the consumption of the myocardium of oxygen and is a selective beta-1-adrainostimulatoram that affect only the receptors of the myocardium of the ventricles. The action of dobutamine is terminated after 3 min after injection. Dobutamine does not increase the glucose content in the blood, it can be used in patients with diabetes mellitus. Dobutamine can be used as angina and acute myocardial infarction.

Way follow illustrate the points parasystole, ventricular premature beats. Periods of accelerated idioventricular rhythm NGOs.

In the selection of antiarrhythmic therapy, while samples with dosed physical load and isoprenaline test was observed sinus tachycardia (140 to 150 in 1 min),which was suppressed by the proposed method: in a horizontal position under ECG and AP control titration method intravenously introduced dobutamine before the occurrence of ectopic activity of the myocardium of the ventricles (frequent ventricular premature beats, accelerated idioventricular rhythm). After the introduction of ratmalana 150 mg intravenously, by injection of dobutamine in the same dose to cause ectopic activity of the myocardium failed. The patient was discharged in satisfactory condition after a 10-day course of treatment with ratmalana. Arrhythmia was not observed.

Example 2. Patient D. 50 years old, diagnosis: myocarditis infarction, ventricular premature beats NCodiabetes mellitus is of moderate severity. Sick implemented the proposed method: in a horizontal position under the control of the ECG and HELL intravenous drip titration method introduced dobutamine before the occurrence of ectopic activity of the myocardium caused by ventricular extras is chopicalqui activity failed. After taking a course etmozina within 2 weeks the patient was discharged in satisfactory condition, ventricular arrhythmia was not observed.

Method of assessment the individual effectiveness of antiarrhythmic drugs in patients with ventricular rhythm disorders without concomitant hypertension by inducing ectopic activity of ventricular myocardium under the control of the ECG, characterized in that it is held twice intravenous administration of the same doses of dobutamine at a rate not exceeding 10 g/kg/min before and at the peak of action antiarrhythmic drug, with an antiarrhythmic drug, on the maximum of which ectopic activity is not provoked, it is considered effective.

 

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