索他洛尔与胺碘酮对运动心电和运动生理的作用比较

目的 比较索他洛尔与胺碘酮对运动心电图和血流动力学的影响。方法 采用单盲、自身前后对照研究索他洛尔与胺碘酮对3l例无器质性心脏病患者运动心电图、运动血压及心率一收缩压乘积的影响。结果 与胺碘酮比较，索他洛尔显著降低运动心率、收缩压及心率一收缩压乘积，不影响心率储备、运动时间和运动当量；与用药前比较，索他洛尔与胺碘酮均显著延长静态和运动各级爪间期，但是在运动过程中，与用药前及胺碘酮比较，索他洛尔致爪间期加速缩短并与心率呈正相关。结论 索他洛尔可显著降低运动氧耗量，有抗心肌缺血作用；和胺碘酮比较，索他洛尔延长运动JTc的作用表现为加速缩短(逆频率依赖现象)，提示其在运动中抗心律失常作用减弱。

Comparison of sotalol and amiodarone on exercise electrocardiogram and physiology in patients without structural heart disease

Objective To compare the effect of sotalol and amiodarone on exercise electrocardiography and hemodynamics.Methods A singnal blind and cross-over study was performed on 31 patients with infrequent premature ventricular contraction or palpitation, who had normal cardiac structure and sinus node function. Three treadmill tests using the Bruce protocol were performed before medication, 3 days after treatment with sotalol (160 mg/day),and a week after treatment with amiodarone (600 mg/d). Exercise testing was terminated because of either fatigue or dyspnea (symptom-limited) in all subjects.Results Sotalol reduced the resting and exercise heart rate, systolic blood pressure and double product, compared with amiodarone and pre-medication. (P<0.001). There was no significant difference in the heart rate reserve and exercise duration between sotalol and amiodarone (P>0.05). Sotalol significantly prolonged JTc interval at rest and each stage of exercise,compared with amiodarone(P<0. 001). During exercise, the shortening of JTc interval was significantly greater with sotalol than with amiodarone (P <0.001). The extent of exercise-induced JTc interval shortening was significantly correlated with heart rate.Conclusion Sotalol significantly decreases oxygen consuption at rest and during exercise, which implies It has anti-ischemic effect. Exercise accelerates the sotalol-induced JTc interval shortening and produces more significant acceleration in ventricular repolarization than with amiodarone, which implies the antiarrhythmic effect of sotalol may be attenuated during exercise.