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β-Blocker bei supraventrikulären Tachyarrhythmien

  • L. Seipel
  • V. Kühlkamp

Zusammenfassung

β-Blocker haben bekanntlich eine negative chronotrope und dromotrope Wirkung auf die Erregungsbildung und -leitung im Herzen. Elektrophysiologische Untersuchungen beim Menschen ergaben nach i. v.-Applikation verschiedener β-Blocker eine Abnahme der Spontanfrequenz des Sinusknotens mit entsprechender Verlängerung der Sinusknotenerholungszeit. Im Bereich des AV-Knotens werden die Leitungs- und Refraktärzeiten verlängert [6,26,33,34,38,39]. Beim Vorliegen einer sog. doppelten AV-Knotenbahn ist dieser leitungsdepressive Effekt sowohl für die „schnelle” als auch für die „langsame“ Bahn nachweisbar [4,23]. Bei β-Blockern mit ausgeprägter sympathikomimetischer Eigenaktivität (ISA) sind diese Effekte naturgemäß weniger ausgeprägt [12,24,42]. Im Bereich anderer kardialer Strukturen wie Vorhofmyokard und akzessorische Bahn beim Präexzitationssyndrom wurden von einzelnen Untersuchern geringe Veränderungen der elektrophysiologischen Eigenschaften beschrieben. Insgesamt sind die Befunde aber nicht einheitlich. Anders verhält es sich mit Sotalol wegen seines zusätzlichen Klasse-III-Effektes.

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Literatur

  1. 1.
    Ahuja RC, Sinja N, Saran RK, Jain AK, Hasan M (1989) Digoxin or verapamil or metoprolol for heart rate control in patients with mitral stenosis - a randomised cross-over study. Int J Cardiol 25: 325–332.PubMedCrossRefGoogle Scholar
  2. 2.
    Amsterdam EA, Kulcyski J, Ridgeway MG (1991) Efficacy of cardioselective beta-adrenergic blockade with intravenously administered metoprolol in the treatment of supraventricular tachyarrhythmias. J Clin Pharmacol 31: 614–718.Google Scholar
  3. 3.
    Atwood JE, Sullivan M, Forbes S, Myers J, Pewen W, Olson HG, Froelicher VF (1987) Effect of beta-adrenergic blockade on exercise performance in patients with chronic atrial fibrillation. J Am Coll Cardiol 10: 314–320.PubMedCrossRefGoogle Scholar
  4. 4.
    Bauernfeind RA, Wandham Ch, Dhingra RC, Swiryn SP, Palileo E, Strasberg B, Rosen KM (1980) Serial electrophysiologic testing of multiple drugs in patients with atrioventricular nodal reentrant paroxysmal tachycardia. Circulation 62: 1341–1349.PubMedGoogle Scholar
  5. 5.
    Bauernfeind RA, Swiryn SP, Strasberg B, Palileo E, Scagliotti D, Rosen KM (1982) Electrophy-siologic drug testing in prophylaxis of sporadic paroxysmal atrial fibrillation: Technique, appli-cation, and efficacy in severely symptomatic preexcitation patients. Am Heart J 103: 941–949.PubMedCrossRefGoogle Scholar
  6. 6.
    Berkowitz WD, Wit AL, Lau SH, Steiner C, Damato AN (1969) The effects of propranolol on cardiac conduction. Circulation 40: 855–862.Google Scholar
  7. 7.
    Borggrefe M, Breithardt G (1985) Elektrophysiologische Wirkung von Sotalol bei supraventri- kularen Tachykardien. Z Kardiol 74: 506–511.PubMedGoogle Scholar
  8. 8.
    Brodsky M, Saini R, Bellinger R, Zoble R, Weiss R, Powers L (1994) Comparative effects of the combination of digoxin and dl-sotalol therapy versus digoxin monotherapy for control of ventricular response in chronic atrial fibrillation. Am Heart J 127: 572–577.PubMedCrossRefGoogle Scholar
  9. 9.
    Byrd RC, Sung RJ, Marks J, Parmley WW (1984) Safety and efficacy of esmolol (ASL-8052: An ultrashort-acting beta-adrenergic blocking agent) for control of ventricular rate in supraven-tricular tachycardias. J Am Coll Cardiol 3: 394–399.PubMedCrossRefGoogle Scholar
  10. 10.
    Camm AJ, Paul VC (1990) Sotalol for paroxysmal supraventricular tachycardias. Am J Cardiol 65: 67A–73A.PubMedCrossRefGoogle Scholar
  11. 11.
    Chang MS, Sung RJ, Tai TY, Lin SL, Liu PH, Chiang BN (1983) Nadolol and supraventricular tachycardia: An electrophysiologic study. J Am Coll Cardiol 2: 894–903.PubMedCrossRefGoogle Scholar
  12. 12.
    Di Biase M, Brindincci G, Rizzon P (1977) Effects of prindolol on impulse formation and con-duction in man. J Electrocardiol 10: 45–50.PubMedCrossRefGoogle Scholar
  13. 13.
    Edvardsson N, Hiukuri H, Kenneback G (1996) Antiarrhythmic efficacy by a class III agent with and without betablockade in chronic atrial fibrillation - A double-blind randomized comparison of dl-sotalol, d-sotalol and placebo. J Am Coll Cardiol 27 (suppl A): 46A.CrossRefGoogle Scholar
  14. 14.
    Esmolol Multicenter Study Research Group (1985) Efficacy and safety of esmolol vs propra¬nolol in the treatment of supraventricular tachyarrhythmias: A multicenter double-blind cli¬nical trial. Am Heart J 110: 913.CrossRefGoogle Scholar
  15. 15.
    Esmolol Research Group (1986) Intravenous esmolol for the treatment of supraventricular tachyarrhythmia: Results of a multicenter, baseline-controlled safety and efficacy study in 160 patients. Am Heart J 112: 498.CrossRefGoogle Scholar
  16. 16.
    Gibson D, Sowton E (1969) The use of beta-adrenergic receptor blocking drugs in dysrhyth-mias. Prog Cardiovasc Dis 12: 16–39.PubMedCrossRefGoogle Scholar
  17. 17.
    Gmeiner R, Keung NC (1982) Metoprolol in the treatment and prophylaxis of paroxysmal reentrant supraventricular tachycardia. J Cardiovasc Pharmacol 4: 5–13.PubMedCrossRefGoogle Scholar
  18. 18.
    Halinen MO, Huttunen M, Paakkinen S, Tarssanen L (1995) Comparison of sotalol with digo- xin-quinidine for conversion of acute atrial fibrillation to sinus rhythm (the sotalol-digoxin- quinidine trial). Am J Cardiol 76: 495–498.PubMedCrossRefGoogle Scholar
  19. 19.
    Hohnloser SH, Van de Loo A, Baedeker F (1995) Efficacy and proarrhythmic hazards of phar-macologic cardioversion of atrial fibrillation: Prospective comparison of sotalol versus quini- dine. J Am Coll Cardiol 26: 852–858.PubMedCrossRefGoogle Scholar
  20. 20.
    James MA, Channer KS, Papouchado M, Rees JR (1989) Improved control of atrial fibrillation with combined pindolol and digoxin therapy. Eur Heart J 10: 83–90.PubMedGoogle Scholar
  21. 21.
    Jordaens L, Gorgels A, Stroobandt R, Temmerman J (1991) Efficacy and safety of intravenous sotalol for termination of paroxysmal supraventricular tachycardia. Am J Cardiol 68: 35–40.PubMedCrossRefGoogle Scholar
  22. 22.
    Juul-Moller S, Edvardsson N, Rehnqvist-Ahlberg N (1990) Sotalol versus quinidine for the maintenance of sinus rhythm after direct current conversion of atrial fibrillation. Circulation 82: 1932–1939.PubMedCrossRefGoogle Scholar
  23. 23.
    Kiihlkamp V, Ickrath O, Haasis R, Seipel L (1988) Elektrophysiologische Effekte von Betaxolol auf Leitungseigenschaften der antegraden und retograden Bahn bei Patienten mit typischer AV-Knoten-Reentrytachykardie nach intravenoser und oraler Gabe. Z Kardiol 77: 527–533.Google Scholar
  24. 24.
    Leclercq JF, Rosengarten, Kural S, Attuel P, Coumel PH (1981) Effects of intrinsic sympathetic activity of beta-blockers on SA and AV nodes in man. Europ J Cardiol 12: 367–375.Google Scholar
  25. 25.
    Maier WD, Neuss H, Bilgin Y, Gigler G, Thormann J, Schlepper M (1983) Beeinflussung der Hamodynamik bei tachykardem Vorhofflimmern durch Metoprolol und Verapamil. Z Kardiol 72: 465–470.PubMedGoogle Scholar
  26. 26.
    Marchlinski FE, Buxton AE, Waxman HL, Josephson ME (1984) ”Electrophysiologic effects of intravenous metoprolol. Am Heart J 107: 1125.PubMedCrossRefGoogle Scholar
  27. 27.
    Mitrovic V, Neuss H, Buss J, Warmann I, Horn HG (1981) Senkung der Herzfrequenz bei chronischem Vorhofflimmern durch Betarezeptoren-Blockade. Herz-Kreisl 10: 493–497.Google Scholar
  28. 28.
    Platia EV, Michelson EL, Porterfield JK, Das G (1989) Esmolol versus verapamil in the acute treatment of atrial fibrillation or atrial flutter. Am J Cardiol. 63: 925–929.PubMedCrossRefGoogle Scholar
  29. 29.
    Rasmussen K, Andersen K, Wang H (1982) Atrial fibrillation induced by atenolol. Eur Heart J 3: 276–281.PubMedGoogle Scholar
  30. 30.
    Rehnqvist N (1981) Clinical experience with intravenous metoprolol in supraventricular tachyarrhythmias. A multicenter study. Ann Clin Res 13 (suppl 30): 68–72.Google Scholar
  31. 31.
    Reimold SC, Cantillon CO, Friedman PL, Antman EM (1993) Propafenone versus sotalol for suppression of recurrent symptomatic atrial fibrillation. Am J Cardiol 71: 558–563.PubMedCrossRefGoogle Scholar
  32. 32.
    Rizos I, Senges J, Jauernig R, Lengfelder W, Czygan E, Brachmann J, Kiibler W (1984) Diffe-rential effects of sotalol and metoprolol on induction of paroxysmal supraventricular tachy-cardia. Am J Cardiol 53: 1022–1027.PubMedCrossRefGoogle Scholar
  33. 33.
    Rizzon P, Di Biase M, Chiddo A, Mastrangelo D, Sorgente L (1978) Electrophysiological pro-perties of intravenous metoprolol in man. Br Heart J 40: 650–655.PubMedCrossRefGoogle Scholar
  34. 34.
    Ruskin JN, Caracta AR, Akhtar M, Batsford WP, Damato AN (1975) Electrophysiologic effects of tolamolol on atrioventricular conduction in man. Am Heart J 90: 755–766.PubMedCrossRefGoogle Scholar
  35. 35.
    Saksena S, Klein GJ, Kowey PR et al. (1987) Electrophysiologic effects, clinical efficacy and safety of intravenous and oral Nadolol in refractory supraventricular tachyarrhythmias. Am J Cardiol 59: 307–312.PubMedCrossRefGoogle Scholar
  36. 36.
    Schoffield PM, Bennett DH (1987) A Comparison of atenolol and sotalol in the treatment of patients with paroxysmal supraventricular tachycardia. J Am Coll Cardiol 9: 247A.Google Scholar
  37. 37.
    Schwartz M, Michelson E, Sawin HS, MacVaugh H (1993) Esmolol: Safety and efficacy in post-operative cardiothoracic patients with supraventricular tachyarrhythmias. Chest 4: 705–711.Google Scholar
  38. 38.
    Seides SF, Josephson ME, Batsford WP, Weisfogel GM, Lau SH, Damato AN (1974) The elec- trophysiology of propranolol in man. Am Heart J 88: 733–741.PubMedCrossRefGoogle Scholar
  39. 39.
    Seipel L, Breithardt G, Dohring HP (1977) Die Wirkung von Atenolol auf den Sinusknoten und die intrakardiale Erregungsleitung beim Menschen im Vergleich zu Propranolol, Z Kar-diol 66: 719–725.Google Scholar
  40. 40.
    Stroobandt R, Kesteloot H (1981) Intravenous metoprolol for the treatment of acute supraven-tricular tachyarrhythmias. Acta Cardiol 36: 155–165.PubMedGoogle Scholar
  41. 41.
    Teo KK, Harte M, Horgan JH (1985) Sotalol infusions in the treatment of supraventricular tachyarrhythmias. Chest 87: 113–118.PubMedCrossRefGoogle Scholar
  42. 42.
    Thormann J, Schwarz F, Zimmermann H (1975) Effects of practolol on A-Vconduction during atrial stimulation in 50 patients with and without coronary heart disease. Basic Res Cardiol 70: 299–306.PubMedCrossRefGoogle Scholar
  43. 43.
    Wong CK, Lau CP, Leung WH, Cheng CH (1990) Usefulness of labetalol in chronic atrial fibrillation. Am J Cardiol 66: 1212–1215.PubMedCrossRefGoogle Scholar
  44. 44.
    Wu D, Denes P, Dhingra R, Khan A, Rosen KM (1974) The effects of propranolol on induction of A-V nodal reentrant paroxysmal tachycardia. Circulation 50: 665–677.PubMedGoogle Scholar
  45. 45.
    Yahalom J, Klein HO, Kaplinsky E (1977) Beta-adrenergic blockade as adjunctive oral therapy in patients with chronic atrial fibrillation. Chest 71: 592–596.PubMedCrossRefGoogle Scholar
  46. 46.
    Zoble RG, Brewington J, Olukotun AY, Gore R (1987) Comparative effects of nadolol-digoxin combination therapy and digoxin monotherapy for chronic atrial fibrillation. Am J Cardiol 60: 39D–45D.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1997

Authors and Affiliations

  • L. Seipel
  • V. Kühlkamp

There are no affiliations available

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