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Apport de l'enregistrement de longue durée de l'ecg dans la conduite du traitement digitalique et bétabloquant de patients en fibrillation auriculaire chronique

par Salhadin, Ph;Bran, Marcel ;De Marneffe, Michel ;Denolin, Henri
Référence Annales de Cardiologie et d'Angeiologie, 32, 4, page (221-224)
Publication Publié, 1983

Article révisé par les pairs

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Résumé :

Three groups of ambulatory patients with chronic atrial fibrillation were studied. In a group of ten patients the dose of digitalis therapy was increased. In a group of 11 patients, the patients received, in addition to an unchanged dose of digitalis therapy, 20 to 40 mg propranolol three times daily. In a group of 10 patients digitalis dose remained unchanged and pindolol, 2,5 to 5 mg three times daily was added to the treatment regimen. Minimal and maximal heart rates were obtained from graphs of ventricular frequencies recorded over a period of 24 hours as well as average cardiac frequencies during physical activity and the lowest mean nocturnal cardiac frequency for three consecutive hours. Also obtained from the recording were the maximal rate on ten consecutive heart cycles and the ten longest cardiac cycles: by averaging them, the virtual minimal heart rate is obtained. Diurnal heart rates fell significantly less after increasing in dose of digitalis (less 6 to 11%) than when propranolol or pindolol was added (less 19 to 25%). Nocturnal rates were lowered in the same proportion by increasing the dose to digitalis or by the addition of propranolol (less 13 to 18%) whilst the addition of pindolol, on the contrary, increased the rate considerably (increase of 19 to 28%). In many cases of patients with artial fibrillation the most appropriate treatment would be a combination of digitalis and a beta-blocker. Their synergic activity during physical activity enable them to be given in low doses. If heart rates during rest and sleep are too high the beta-blocker used with the digitalis should be one without (ISA) intrinsic sympathicomimetic activity. On the other hand if rates are low a beta-blocker with ISA is to be preferred. The sympathicomimetic properties of some beta-blockers have definite clinical applications here.