Zusammenfassung
Die antiarrhythmischen Wirkprofile von Chinidin und Verapamil werden dargestellt. Für Verapamil sind die Angriffspunkte am Sinus- und AV-Knoten mit ihren Ca++-getragenen Aktionspotentialen von Bedeutung. Verapamil verlangsamt primär die Sinusknotenentladung, jedoch wird dieser Effekt durch Rückwirkungen aus der Peripherie bei ungestörter Sinusknotenfunktion kompensiert. Es verlängert die AV-Refraktärzeit und vermindert die AV-Leitungskapazität. Es senkt daher bei Vorhofflimmern die Kammerfrequenz. Bei ca. 30% der Patienten mit ventrikulären Tachykardien ist Verapamil wirksam, was auf mögliche Hemmung langsamer Aktionspotentiale in teildepolarisierten Arealen zurückgeführt wird. Sieht man Verapamil als klassischen Vertreter der Klasse-IV-Antiarrhythmika an, stellt Chinidin den Prototyp eines Klasse-I-Antiarrhythmikums dar. Die Wirkung von Chinidin ist demnach vorwiegend auf die schnellen Natriumkanäle gerichtet. Die anticholinerge Wirkung zusammen mit der Verlängerung der Refraktärzeit des Vorhofmyokards begründet die in vielen Studien nachgewiesene gute Wirkung des Chinidin insbesondere bei Vorhofflimmern. Die große Anzahl der zur antiarrhythmischen Wirksamkeit von Chinidin vorliegenden Arbeiten zeigt, daß Chinidin nicht unbedingt einem neuen Antiarrhythmikum in bezug auf die Wirksamkeit bei ventrikulären Rhythmusstörungen unterlegen zu sein braucht, und daß die Erfolgsquote von Chinidin sich durchaus vergleichen läßt mit der anderer Antiarrhythmika, jedoch das Nebenwirkungsprofil und die Interaktionen mit anderen Arzneimitteln besonderer Beachtung bedürfen.
Summary
The antiarrhythmic profiles of action of quinidine and verapamil are described. The sites of action at the sinus and AV nodes with their Ca2+ mediated action potentials are of importance for verapamil. The primary effect of verapamil is that it slows down sinus node depolarization. In normal sinus node function this effect is, however, compensated for by a reaction from the periphery. It prolongs the AV refractory period and reduces the AV conduction capacity. Hence, it decreases the ventricular rate in atrial fibrillation. Verpamil is effective in about 30% of patients with ventricular tachycardia which is attributed to a possible inhibition of slow action potentials in partly depolarized areas. If verapamil is regarded as a typical class IV antiarrhythmic drug quinidine is the prototype of a class I antiarrhythmic drug. Hence, the effect of quinidine is primarily directed at the fast sodium channels. As confirmed in many studies the favourable effect of quinidine in particular in atrial fibrillation is based on its anticholinergic action along with a prolonged refractory period of the atrial myocardium. The great number of publications on the antiarrhythmic efficacy of quinidine available shows that quinidine is not necessarily inferior to a new antiarrhythmic drug as regards efficacy in ventricular arrhythmia. Its rate of success is easily comparable with that of other antiarrhythmic drugs but its profile of side effects and interactions with other drugs should be given particular consideration.
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© 1985 Dr. Dietrich Steinkopff Verlag, GmbH & Co. KG, Darmstadt
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Schlepper, M. (1985). Antiarrhythmisches Wirkungsprofil von Verapamil und Chinidin. In: Bender, F., Greeff, K. (eds) Kombinationstherapie der Herzrhytmusstörungen mit Chinidin und Verapamil. Steinkopff. https://doi.org/10.1007/978-3-642-85346-3_3
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