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CARDIOLOGY AND CARDIO SURGERY

INVENTION
Patent of the Russian Federation RU2070038

METHOD OF ESTIMATION OF INDIVIDUAL EFFICIENCY OF ANTIARRHYTHMIC PREPARATION

METHOD OF ESTIMATION OF INDIVIDUAL EFFICIENCY OF ANTIARRHYTHMIC PREPARATION

The name of the inventor: Bobrov Vladimir Alekseevich [UA]; Frolov Alexander Ivanovich [UA]; Mitchenko Elena Ivanovna [UA]; Galichansky Igor Vasilievich [UA]; Chervonopiska Elena Mikhailovna
The name of the patent holder: Ukrainian Scientific Research Institute of Cardiology named after N.D. Strazhesko
Address for correspondence:
Date of commencement of the patent: 1992.08.25

The invention relates to medicine, cardiology. Essence: the ectopic activity of the myocardium is provoked by the administration of dobutamine before and at the peak of the effect of the antiarrhythmic drug. The drug is considered effective, against the background of which the arrhythmia does not cause dobutamine in the same dose.

DESCRIPTION OF THE INVENTION

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

A method for evaluating the individual efficacy of an antiarrhythmic drug is known in which a discrete administration of isoprenaline is used to monitor the ventricular tachyarrhythmia in a controlled manner before and at the maximum of the antiarrhythmic drug. At the same time, the drug is considered effective, the expected maximum of which the arrhythmia was not reproduced. (Bobrov VA, Mitchenko E, I. Frolova AI Simorot VN A method for evaluating the individual efficacy of an antiarrhythmic drug., Authors SSSR No. 1586674, A61 / B 5/00, 1990).

However, the use of isoprepaline has the following drawbacks. With the introduction of isoprepalin, a significant increase in the sinus rhythm is observed, which suppresses the ectopic activity of the ventricles and does not allow us to identify the focus of arrhythmia. Isoprenaline, increasing myocardial oxygen demand without increasing coronary blood flow, in patients with coronary heart disease can lead to exacerbation of the disease, including an attack of angina or myocardial infarction, the action of isoprenaline ceases 30-40 minutes after the end of the injection, which can lead to prolonged Provoked by ventricular arrhythmias, but also to the instability of the hemodynamics of the patient. Isoprenaline is a stimulant for both beta-1 and beta-2-adrenergic receptors, with the stimulation of which there is pronounced vasodilation and a decrease in blood pressure, even without the appearance of ectopic myocardial activity, which leads to a violation of the hemodynamics of the patient. Isoprenaline can increase the level of glucose and lactic acid in the blood, which limits its use in patients with diabetes mellitus.

The proposed method is free from these drawbacks, since with the administration of dobutamine by titration it is possible to achieve activation of the ectopic focus in the myocardium without increasing the sinus rhythm. Dobutamine does not disturb the balance in the process of "myocardial oxygen demand for oxygen delivery" and is used in both angina pectoris and acute infarction. The action of dobutamine is stopped 3 minutes after the end of the injection. Dobutamine is a selective beta-1-adrenostimulator and affects only receptors in the myocardium of the ventricles. Dobutamine does not increase the glucose level in the blood, which makes it possible to use it in diabetic patients.

The aim of the invention is to increase the safety and informative nature of the method, and to expand the contingent of the patients being surveyed.

The 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 up to and at the maximum of the antiarrhythmic drug, and that drug is considered effective, at the maximum of which there is no arrhythmia.

The method is carried out in the following way: the patient under the control of ECG and AD is administered intravenously drip, by titrating dobutamine 250 mg in 250 ml of 5-glucose before the occurrence of ectopic myocardial activity at a rate of not more than 10 μg / kg / min. In case of provoking ventricular arrhythmia, the administration of dobutamine is stopped and intravenous antiarrhythmic drug is administered: metoprolol 0.2 mg / kg of weight, amiodarone 5 mg / kg, rhythmelin 2 mg / kg, obzidan 1 mg, etmozin 150 mg. Then, at the expected maximum of the antiarrhythmic drug, dobutamine is reintroduced in the same dose. Antiarrhythmic drug, at the expected maximum of which to provoke ectopic activity of the ventricular myocardium can not be considered effective. In the absence of efficacy, the sample is repeated with another anti-arrhythmic drug after a time period of 3 5 half-lives of the previously administered antiarrhythmic drug.

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

The method has obvious advantages in comparison with the prototype, since with the administration of dobutamine by titration it is possible to achieve activation of the ectopic focus in the myocardium without increasing the sinus rhythm. Dobutamine does not disturb equilibrium in the process of oxygen consumption by myocardium and is an selective beta-1-adrenostimulant that affects only the ventricular myocardial receptors. The action of dobutamine is stopped 3 minutes after the end of the injection. Dobutamine does not increase the glucose level in the blood, which makes it possible to use it in patients with diabetes mellitus. Dobutamine can be used in both angina pectoris and acute 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, during a sample with a dosed physical load and an isoprenaline test, sinus tachycardia (140-150 per min) was observed, which suppressed the proposed method: in the horizontal position under the ECG and AD control by titration intravenously, dobutamine was injected drastically before the occurrence of ectopic activity Myocardial ventricles (frequent ventricular extrasystole, accelerated idioventricular rhythm). After the administration of rhythmilene 150 mg intravenously, administration of dobutamine at the same dose, it was not possible to provoke ectopic activity of the myocardium. The patient was discharged in a satisfactory condition after a 10-day course of rhythmolene treatment. Extrasystoles were not observed.

Example 2 . Patient D. 50 years old, diagnosis: myocarditis cardiosclerosis, ventricular extrasystole NK O , diabetes mellitus moderate. The patient carried out the proposed method: in a horizontal position under the control of ECG and AD, intravenously, titration was administered intravenously with dobutamine before the occurrence of ectopic myocardial activity, ventricular extrasystology as biguenia was induced. After the administration of etmosin, 150 mg repeated introduction of dobutamine provoke ectopic activity failed. After a course of taking ethmosin for 2 weeks, the patient was discharged in a satisfactory state, no ventricular extrasystole was observed.

CLAIM

A method for evaluating the individual efficacy of an antiarrhythmic drug in patients with ventricular rhythm disturbances without concomitant hypertension by provoking ectopic ventricular myocardial activity under ECG monitoring, characterized in that a double intravenous administration of identical doses of dobutamine at a rate of not more than 10 μg / kg / min before and at a maximum The action of the antiarrhythmic drug, while the antiarrhythmic drug, at the maximum of which ectopic activity is not provoked, is considered effective.

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Date of publication 05.04.2007gg