循環器ジャーナル65巻3号

2017年07月発行

特集 不整脈診療—ずっと疑問・まだ疑問 Ⅳ．抗不整脈薬のヒント

夜間好発の心房細動に抗コリン作用をもつ抗不整脈薬を使う根拠はあるか

著者： 小松隆¹

所属機関： ¹岩手医科大学内科学講座心血管・腎・内分泌内科分野

ページ範囲：P.508 - P.516

Point
・心房細動の原因を検索することは病態把握のみならず，治療戦略を決定するうえでも重要である．
・好発時間帯からみた薬剤選択法により，従来の経験的投与法や試行錯誤的投与法に比し治療効率の良い薬剤選択が可能となる．
・抗不整脈薬の投与は，患者背景のリスク/ベネフィットのバランスを配慮して行うことが重要である．

参考文献

1) Yamashita T, Murakawa Y, Sezaki K, et al:Circadian variation of paroxysmal atrial fibrillation. Circulation 96:1537-1541, 1997

2) Jais P, Haissaguerre M, Shah DC, et al:A focal source of atrial fibrillation treated by discrete radiofrequency ablation. Circulation 95:572-578, 1997

3) Ikeda T, Czer L, Hwang C, et al:Induction of meandering functional reentrant wavefront in isolated human atrial tissues. Circulation 96:3013-3020, 1997

4) Allessie MA, Lammers WJEP, Bonke FIM, et al:Experimental evaluation of Moe's multiple wavelet hypothesis of atrial fibrillation. In:Zipes DP, Jalife J, eds. Cardiac electrophysiology and arrhythmias. Grune ＆ Stratton, Orlando, pp265-283, 1985

5) Li I, Nattel S:Differing sympathetic and vagal effects on atrial fibrillation in dogs:role of refractoriness heterogeneity. Am J Phsiol 273:H805-H816, 1997

6) Patterson E, Po SS, Scherlag BJ, et al:Triggered firing in pulmonary veins initiated by in vitro autonomic nerve stimulation. Heart Rhythm 2:624-631, 2005

7) Schauerte P, Scherlag BJ, Pitha J, et al:Catheter ablation of cardiac autonomic nerves for prevention of vagal atrial fibrillation. Circulation 102:2774-2780, 2000

8) Scherlag BJ, Yamanashi W, Patel U, et al:Autonomically induced conversion of pulmonary vein focal firing into atrial fibrillation. J Am Coll Cardiol 45:1878-1886, 2005

9) Razavi M, Zhang S, Yang D, et al:Effects of pulmonary vein ablation on regional atrial vagal innervation and vulnerability to atrial fibrillation in dogs. J Cardiovasc Electropyhsiol 16:879-884, 2005

10) Yamashita T, Murakawa Y, Hayami N, et al:Relation between aging and circadian variation of paroxysmal atrial fibrillation. Am J Cardiol 82:1364-1367, 1998

11) Tomita T, Takei M, Saikawa Y, et al:Role of autonomic tone in the initiation and termination of paroxysmal atrial fibrillation in patients without structural heart disease. J Cardiovasc Electrphysiol 14:559-564, 2003

12) 栗田康生，三田村秀雄，竹下晃子，他：電気的リモデリングを受けた心房筋の細動誘発性に対する迷走神経緊張の関与．心電図20:628-634, 2000

13) 小松　隆，蓬田邦彦，奥村　謙，他：発症時間帯からみた発作性心房細動に対するDisopyramideの停止効果・長期予防効果．心臓33:29-35, 2001

14) 小松　隆，中村　紳，奥村　謙，他：発作性心房細動に対するcibenzolineの停止効果・長期予防効果—発症時間帯による比較検討—．J Cardiol 37:75-82, 2001

15) 小松　隆，中村　紳，奥村　謙，他：発作性心房細動例における発症時間帯とpilsicainideの長期再発予防効果との関連．J Cardiol 38:211-217, 2001

16) Komatsu T, Nakamura S, Okumura K, et al:Efficacy of long-term flecainide therapy in patients with paroxysmal atrial fibrillation:analysis based on time of onset. J Arrhythmia 22:37-43, 2006

17) 渡辺英一，荒川友晴，内山達司，他：Ⅰ群抗不整脈薬による発作性心房細動の予防：概日リズムを考慮した薬剤の使い分け．心電図23:45-52, 2003

18) Yesil M, Bayata S, Postaci N, et al:Cardioversion with sotalol in selected patients with vagally and adrenergically mediated paroxysmal atrial fibrillation. Angiology 50:729-733, 1999

score and efficacy of antiarrhythmic drug therapy in patients with paroxysmal atrial fibrillation. Circ J 77:639-645, 2013

20) Komatsu T:Current strategy of the antiarrhythmic drug therapy for paroxysmal atrial fibrillation. J Arrhythmia 28:162-169, 2012

21) Flaker GC, Blackshear JL, McBride R, et al:Antiarrhythmic drug therapy and cardiac mortality in atrial fibrillation. The Stroke Prevention in Atrial Fibrillation Investigators. J Am Coll Cardiol 20:527-532, 1992

22) Komatsu T, Tachibana H, Nakamura M, et al:Clinical profiles, efficacy of antiarrhythmic drug therapy and cardiovascular prognosis in patients with first-detected paroxysmal atrial fibrillation. Int Heart J 52:32-38, 2011