山东大学药理学研究所丁华dinghuasduedu

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Section 1
The Physiological Basis of Arrhythmia
1. The electrophysiology of normal 2. cardiac rhythm
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2. The electrophysiological mechanism of arrhythmias
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Therapeutic Uses: Broad-spectrum
Atrial fibrillation; Atrial flutter; Supraventricular and ventricular
b. ↓ K+ efflux , Increase the ERP
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Quinidine(奎尼丁)
Pharmacological Effects: Cardiac Effects:
↓autorhythmicity;↓conduction;↑ERP ↓myocardial contractility Extracardiac Effects: α-adrenergic blocking anticholinergic effect
Sicilian gambit (1991)
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Section 3 Specific Antiarrhythmic Agents
1. ClassⅠ Sodium channelblocking agents
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钠通道阻滞剂的分类
分类 药物 钠阻滞强度 结合/解离常数 心电图表现 状态依赖
1)↓automaticity (autorhythmicity) a.↓slope of phase 4 depolarization: ↓Na+in or Ca2+in b.↑Threshold potential c.↑maximum diastolic potential: ↑K+out D. ↑APD ↓ K+out
CHAPTER 25
ANTIARRHYTHMIC DRUGS
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Arrhythmia:
Arrhythmias consist of cardiac depolarizations
that deviate from the sinus百度文库rhythm--ie, There is an abnormality in the site of origin of the impulse, its rate or regularity , or its conduction .
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(3) Disturbances in impulse conduction
1) Simple conduction disturbances: conduction ↓ conduction block
2) Reentry (circus movement)
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IA 奎尼丁
普鲁卡因胺 ++
1—10秒
延长QT 激活态
IB 利多卡因
美西律
+
<1秒
不明显 失活态
IC 普罗帕酮
氟卡尼
+++
>10秒
QRS增宽 激活态
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1) ClassⅠA
a. Inhibit Na+ influx moderately : ↓Vmax, ↓conduction ↓phase 4 slope, ↓automaticity
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2)↓EAD or DAD:
Accelerate repolarization,
Block Na+ in or Ca2+ in
3) Avoid reentry: a.↑conduction:↓unidirectional block b.↓conduction : unidirectional block
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The types of Arrhythmia:
缓慢型 : 窦性心动过缓 (sinus bradycardia) 房室传导阻滞 (atrio-ventricular block)
快速型 : 房性早搏 (atrial premature contraction) 房性心动过速 (atrial tachycardia,AT) 心房颤动 (atrial fibrillation, AF) 心房扑动 (atrial flutter, AFL) 阵发性室上性心动过速 (paroxysmal supraventricular tachycardia) 室性早搏 (ventricular premature contraction) 室性心动过速 (ventricular tachycardia,VT) 心室颤动 (ventricular fibrillation, VF)
→ bidirectional block c.↑ERP
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2.The classification Class by Vaughan Williams （1971）
ClassⅠ Sodium channel-blocking
agents: IA , IB, IC ClassⅡ β-R blockers Class Ⅲ Prolonging APD agents Class Ⅳ Calcium channel blockers
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Section 2
The Basic Electrophysiology Action of Antiarrhythmic Drugs and The Classification of Drugs
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1. The basic electrophysiology action
(1) Disturbances in impulse formation: Increased automaticity
(2) Afterdepolarization and triggered activity: Early afterdepolarization (EAD) Delayed afterdepolarization (DAD)