Statistical analysis of medication information labeling of pregnant women and lactating women in the instructions of antiarrhythmic drugs / 中国药房

OBJECTIVE To provide reference for standardizing the labeling of medication information for pregnant women and lactating women in the instructions of antiarrhythmic drugs. METHODS The instructions of antiarrhythmic drugs were collected from the terms of “medication reference ”on official website of Yimaitong Technology Co. ，Ltd. The labeling of medication information of pregnant women and lactating women were sorted out ，counted and analyzed with reference to the Detailed Rules for Specifications of Instructions of Chemical Drugs and Therapeutic Biological Products issued by the State Food and Drug Administration. RESULTS A total of 111 instructions of antiarrhythmic drugs were collected in this study ，of which 102 instructions were marked with “medication for pregnant women ”（91.89％），of which the proportion of those with medication guidance and without medication guidance were 75.68％ and 16.22％ respectively. Eighty-eight drug instructions were marked with the item “medication for lactating women ”（79.28％），of which the proportion of those with medication guidance and without medication guidance were 70.27％ and 9.01％ respectively. Among different categories of antiarrhythmic drugs ，the best labeling of “medication for pregnant women ”was class Ⅰ antiarrhythmic drugs （100％），while class Ⅲ drugs（25.00％）were most missing ； class Ⅳ antiarrhythmic drugs （94.44％）were the best labeled for “medication for lactating women ”，while class Ⅰ（26.47％）were the most missing . There were differences in the labeling contents of “medication for pregnant women ”and“medication for lactating women ”in some drug instructions of the same variety from different manufacturers. Among the 99 drug instructions of domestic pharmaceutical enterprises ， 92 listed the items of “medication for pregnant women”and“medication for lactating women ”，and the proportions of them with medication guidance were 74.75％ and 69.70％ respectively；among the 12 drug instructions of foreign pharmaceutical enterprises ，10（83.33％）listed the items of “medication for pregnant women ”and“medication for lactating women ”，and the proportion with medication guidance was 83.33％ and 75.00％ respectively. CONCLUSIONS There are some problems in the labeling content of domestic antiarrhythmic drug instructions，such as the lack of information related to “medication for pregnant women ”and“medication for lactating women ”， the confusion of guidance expression ， the inconsistent content of drug instructions of the same variety from different manufacturers，the lag of modification and update ，and the poor standardization of drug instructions. Drug supervision and administration departments and drug manufacturers should pay attention to them and constantly strengthen the management and standardization of instructions.

Efecto electromecánico de los antiarrítmicos clase Ic durante el tratamiento de arritmias auriculares en cardiopatías congénitas / Electromechanical effect of Ic class antiarrhythmic drugs during the treatment of atrial arrhythmias in congenital heart diseases

Introducción: los fármacos antiarrítmicos son la primera línea de tratamiento para el control de las taquiarritmias en el paciente pediátrico. La terapéutica con drogas clase Ic en los pacientes con cardiopatías congénitas ha sido limitada, por los reportes que demostraron incremento de la mortalidad en los sujetos con cardiopatías estructurales. Objetivo: valorar el efecto de los antiarrítmicos clase Ic sobre los fenómenos electro-mecánicos cardiacos en los niños con cardiopatías congénitas con arritmias auriculares. Métodos: se realizó un estudio analítico, observacional, longitudinal y prospectivo en los pacientes con cardiopatías congénitas que desarrollaron arritmias auriculares, tratados con antiarrítmicos clase Ic en el Cardiocentro Pediátrico William Soler . Se analizaron variables electrocardiográficas, así como estimación de la función sistodiastólica mediante el ecocardiograma. Resultados: fueron evaluados 46 pacientes, 25 tratados con flecainida (grupo I) y 21 con propafenona (grupo II) durante 4,57±0,86 años. La taquicardia por reentrada intraatrial fue la arritmia de mayor incidencia (58,69 por ciento), mientras que, la tetralogía de Fallot, el defecto cardiaco más común (36,9 por ciento). Las variables electrocardiográficas no sufrieron variaciones nítidas durante el seguimiento. El análisis comparativo intragrupal demostró la preservación de la función sistólica en la totalidad de los sujetos (I, p= 0,275; II, p= 0,262). Comportamiento análogo exhibió la función diastólica, expresada en el índice de Tei (I, p= 0,244; II, p= 0,286). Conclusiones: la utilización de antiarrítmicos clase Ic en los pacientes pediátricos con cardiopatías congénitas no se asocia a largo plazo con alteraciones electrocardiográficas significativas ni compromiso de la función sistodiastólica, por lo que se recomienda su uso en esta población(AU)

Introduction: antiarrhythmic drugs are the first line of treatment for the control of tachyarrhythmias in pediatric patients. Therapy with Ic class drugs in patients with congenital heart disease has been limited, mainly due to reports that showed an increase in mortality in patients with structural heart disease. Objective: to assess the effect of Ic class antiarrhythmic drugs on cardiac electro-mechanical phenomena in children with congenital heart disease with atrial arrhythmias. Methods: an analytical, observational, longitudinal and prospective study was performed in patients with congenital heart diseases who developed atrial arrhythmias treated with Ic class antiarrhythmic drugs in William Soler Pediatric Cardiocenter. Electrocardiographic variables were analyzed, as well as the estimation of systo-diastolic function by echocardiography. Results: 46 patients were evaluated, 25 treated with flecainide (group I) and 21 with propafenone (group II) during 4.57 ± 0.86 years. The intra-atrial reentrant tachycardia was the arrhythmia with the highest incidence (58.69 percent); while tetralogy of Fallot was the most common cardiac defect (36.9 percent). The electrocardiographic variables did not undergo sharp variations during the follow-up. The intergroup comparative analysis showed the preservation of systolic function in all subjects (I, p= 0.275; II, p= 0.262). Analogous behavior showed diastolic function, that was expressed in the Tei index (I, p= 0.244; II, p= 0.286). Conclusions: the use of Ic class antiarrhythmic drugs in pediatric patients with congenital heart disease is not associated in the long term with significant electrocardiographic alterations or compromise of systo-diastolic function, so its use is recommended in this population(AU)

Antiarrhythmic drug usage and prostate cancer: A population-based cohort study / 亚洲男科学杂志(英文版)

Even though the relationship between antiarrhythmic drug usage and subsequent prostate cancer (PCa) risk has recently been highlighted, relevant findings in the previous literature are still inconsistent. In addition, very few studies have attempted to investigate the association between sodium channel blockers or potassium channel blockers for arrhythmia and the subsequent PCa risk. Therefore, this cohort study aimed to find the relationship between antiarrhythmic drug usage and the subsequent PCa risk using a population-based dataset. The data used in this study were derived from the Longitudinal Health Insurance Database 2005, Taiwan, China. We respectively identified 9988 sodium channel blocker users, 3663 potassium channel blocker users, 65 966 beta-blocker users, 23 366 calcium channel blockers users, and 7031 digoxin users as the study cohorts. The matched comparison cohorts (one comparison subject for each antiarrhythmic drug user) were selected from the same dataset. Each patient was tracked for a 5-year period to define those who were subsequently diagnosed with PCa. After adjusting for sociodemographic characteristics, comorbidities, and age, Cox proportional hazard regressions found that the hazard ratio (HR) of subsequent PCa for sodium channel blocker users was 1.12 (95% confidence interval [CI]: 0.84-1.50), for potassium channel blocker users was 0.89 (95% CI: 0.59-1.34), for beta-blocker users was 1.08 (95% CI: 0.96-1.22), for calcium channel blocker users was 1.14 (95% CI: 0.95-1.36), and for digoxin users was 0.89 (95% CI: 0.67-1.18), compared to their matched nonusers. We concluded that there were no statistical associations between different types of antiarrhythmic drug usage and subsequent PCa risk.

Clinical value and safety of antiarrhythmic drugs in the treatment of atrial fibrillation / 中国生化药物杂志

Objective To investigate the clinical value and safety of cedilanid, esmolol in the treatment of atrial fibrillation. Methods From August 2014 to August 2016 our Hospital from 117 patients with atrial fibrillation clinical data, according to the random number distribution principle, the patients were divided into observation group 59 cases and control group of 58 cases, all patients were given the treatment of primary disease, the clinical symptoms, the patients in the observation group were given oxygen, has given furosemide, cedilanid, after micro injection pump intravenous nitroglycerin, 5-20 g/min. Start after the injection of nitroglycerin, establish another vein channel, every 30 min to 0.2 mg patients, the treatment group were treated with intravenous injection of small dose esmolol. The clinical efficacy, ventricular rate, systolic blood pressure, diastolic blood pressure and adverse reactions were observed in two groups. Results The early and late effective rates of the two groups were not significantly different. The observation showed that after treatment, the ventricular rate, systolic pressure and diastolic pressure in the observation group were significantly higher than those in the control group (P<0.05), and the incidence of adverse reactions in the two groups was significantly different (P<0.05). Conclusion High dose cedilanid combined with small dose esmolol in treatment of atrial fibrillation, obvious curative effect, high safety, can choose the appropriate application.

Estado actual de la ablación de la fibrilación auricular / Current status on atrial fibrillation ablation

La fibrilación auricular es la arritmia más común en la práctica clínica. La ablación se considera el tratamiento de elección (indicación clase I) en los pacientes sintomáticos con recurrencias a pesar del tratamiento con fármacos antiarrítmicos. El presente artículo revisa tanto los mecanismos propuestos de esta arritmia como las diferentes metodologías de ablación con catéter y sus indicaciones.

Summary Atrial fibrillation is the most common arrhythmia in clinical practice. Catheter ablation is the treatment of choice (Class I indication) for symptomatic patients with recurrences despite antiarrhythmic drugs. The present article reviews the proposed mechanisms of this arrhythmia and the different ablation methods and indications.

EFECTO DEL FÁRMACO CLOROQUINA EN LA TERMINACIÓN DE UN ROTOR DURANTE FIBRILACIÓN AURICULAR PAROXÍSTICA. ESTUDIO DE SIMULACIÓN / CHLOROQUINE DRUG EFFECT ON A ROTOR TERMINATION DURING PAROXYSMAL ATRIAL FIBRILLATION. A SIMULATION STUDY / O EFEITO DO MEDICAMENTO CLOROQUINA NO FECHAMENTO DE UM ROTOR DURANTE FIBRILAÇÃO ATRIAL PAROXÍSTICA. SIMULAÇÃO ESTUDO

La fibrilación auricular (FA) es la arritmia más común. Algunos episodios de FA son mantenidos por rotores. La FA paroxística (FAp) se refiere a episodios recurrentes que se autolimitan. Si la FAp no se trata puede convertirse en crónica. Se ha demostrado que la inhibición de las corrientes I KACh e I K1 contribuye a la terminación de la FA. El fármaco antimalárico cloroquina, al inhibir estas corrientes podría ser un fármaco antiarrítmico eficaz en humanos. El objetivo del trabajo es simular los efectos de la cloroquina y estudiar su eficacia en la terminación de un rotor en condiciones de FAp. Para esto, se desarrolló un modelo 2D de tejido auricular en condiciones de FAp. Se implementó un modelo del efecto de la cloroquina sobre las corrientes I K1 e I KACh para estudiar su eficacia en la terminación de un rotor simulado. La cloroquina alargó el potencial de acción a medida que se incrementó su concentración. A concentraciones de 0.3 µM y superiores, finalizó la actividad del rotor. Este es el primer trabajo que ha desarrollado modelos matemáticos del fármaco cloroquina para estudiar su efecto en la terminación de un rotor. Los resultados sugieren que la cloroquina podría ser un potente agente antiarrítmico en el tratamiento de la FAp.

Atrial fibrillation (AF) is the most common arrhythmia. Some AF episodes are maintained by rotors. Paroxysmal AF (pAF) refers to self-limiting recurrent episodes. If the pAF is not treated it could become chronic. It has been demonstrated that inhibition of the I K1 and I KACh currents contributes to AF termination. Antimalarial drug chloroquine by inhibiting these currents could be an effective antiarrhythmic drug in humans. The aim of this work is to simulate the effects of chloroquine and study their effectiveness in the rotor termination in pAF conditions. For this, we developed a 2D model of atrial tissue under pAF conditions. We implemented a model of the effect of chloroquine on I K1 and I KACh currents to study its effectiveness in the termination of a simulated rotor. Chloroquine lengthened the action potential as the concentration increased. At concentrations of 0.3 µM and higher, the activity of the rotor finished. This is the first work that developed a chloroquine mathematical models to study its effect on the rotor termination. The results suggest that chloroquine could be a potent antiarrhythmic drug for the pAF treatment.

A fibrilhação auricular (FA) é a arritmia mais comum. Alguns episódios de FA são mantidos por rotores. A FA paroxística (FAp) refere-se a episódios recorrentes que são autolimitantes. Se a FAP não tem nenhum tratamento, pode se tornar crônica. Tem sido demonstrado que a inibição das correntes I KACh e I K1 contribui para o término da AF. O medeicamento antimalárico cloroquina, para inibir essas correntes poderia ser um medicamento anti-arrítmico eficaz em seres humanos. O objetivo deste trabalho é simular os efeitos da cloroquina e estudar a sua eficácia na terminação de um rotor capaz em condições FAp. Para isso, um modelo 2D foi desenvolvido de tecido auricular em condições de FAp. foi implementado um modelo do efeito da Cloroquina sobre as corrente I K1 e I KACh para estudar a sua eficácia na terminação de um rotor simulado. A Cloroquina alongou o potencial de ação na medida em que foi aumentada a sua concentração. Em concentrações de 0,3 µM e superiores, terminou a atividade do rotor. Este é o primeiro trabalho que desenvolveu modelos matemáticos do medicamento cloroquina para estudar seu efeito sobre a terminação de um rotor. Os resultados sugerem que a cloroquina poderia ser um potente agente anti-arrítmico para o tratamento de FAp.

Principios básicos de las nuevas estrategias farmacológicas antiarrítmicas en fibrilación auricular / Basic mechanisms of the new antiarrhythmic drugs in atrial fibrillation

La fibrilación auricular (FA) es la arritmia crónica sostenida más frecuente en la población general. A pesar de los últimos avances tecnológicos y en el entendimiento de sus mecanismos, derivados de modelos experimentales, así como de los procedimientos de ablación en pacientes con FA, los fármacos antiarrítmicos siguen siendo la principal estrategia para la cardioversión y mantenimiento del ritmo sinusal. Nuevas generaciones de fármacos antiarrítmicos han llegado a la práctica clínica, y otros se encuentran en fase de experimentación. Los nuevos fármacos actúan de forma más específica sobre corrientes iónicas auriculares, y al mismo tiempo involucradas en el mantenimiento de la arritmia. Paralelamente, cada vez se da más importancia a la necesidad de actuar sobre el sustrato arritmogénico auricular y los factores que lo promueven, implicados en el mantenimiento a largo plazo de la arritmia (terapias upstream). La presente revisión tiene como objetivo exponer las actuales líneas de desarrollo en fármacos antiarrítmicos y terapias para prevención o retraso del remodelado auricular, con base a los conocimientos mecanísticos que hoy en día se involucran en el mantenimiento de la FA.

Atrial fibrillation (AF) is the most common sustained arrhythmia seen in clinical practice. Despite of new technological breakthroughs and the understanding of the mechanisms underlying AF, based on animal models and ablation procedures in patients, the antiarrhythmic drugs remain the main therapeutic strategy to restore and maintain the sinus rhythm. New antiarrhythmic drugs are already available in the clinical practice and many others are under development. The new antiarrhythmic drugs have the capability to block atrial-specific ionic currents, which are involved in the maintenance of the arrhythmia. Parallel, increasing evidence supports the use of compounds to regulate the arrhythmogenic atrial substrate involved in the long-term maintenance of the arrhythmia (upstream therapies). This article reviews the new antiarrhythmic drugs and upstream therapies, based on the current knowledge of the mechanisms involved in the maintenance of AF.

Taquicardia ectópica congénita de la unión: Tratamiento farmacológico en el primer año de vida / Congenital junctional ectopic tachycardia: Pharmacologic management during infancy

La forma congénita de la taquicardia ectópica de la unión (TEU) es una arritmia poco frecuente que suele presentar dificultades en su manejo farmacológico, con altas tasas de morbilidad y mortalidad. El objetivo de este trabajo fue informar la experiencia en el seguimiento y el tratamiento de esta forma de taquicardia supraventricular en pacientes menores de un año. Se identificaron siete pacientes con TEU congénita en 28 meses de seguimiento entre 2008 y 2010. El diagnóstico fue realizado en el primer día de vida en cuatro pacientes y dentro de los 150 días de vida en los 3 restantes. Sólo dos presentaron miocardiopatía dilatada. Ninguno presentó cardiopatía estructural. Se utilizó amiodarona en todos los pacientes, en un caso como única droga, asociándose a propanolol en cuatro. En un paciente se asoció flecainida a estos dos fármacos y en otro se la combinó con amiodarona. En un tiempo de seguimiento con un rango de 1-28 meses (media 12.2 meses, mediana 9.75 meses) en tres de los pacientes se consiguió obtener ritmo sinusal alternante con taquicardia nodal lenta; ninguno presentó efectos adversos secundarios a la medicación, ni deterioro de la función ventricular. Hubo sólo una muerte en el grupo estudiado. En conclusión, la combinación de fármacos antiarrítmicos (amiodarona más propranolol y eventualmente flecainida) constituye una alternativa válida para un adecuado control de la TEU congénita en pacientes menores de un año de edad.

Congenital junctional ectopic tachycardia (JET) is a rare arrhythmia that can be refractory to medical therapy with high morbidity and mortality rates. The aim of this study was to report our experience with pharmacologic management of congenital JET in infants. Seven patients with congenital JET were identified between 2008 and 2010. Only two of them presented dilated cardiomyopathy. There were no congenital structural defects. Amiodarone was given to all the patients, as single therapy in one, and in combination with propranolol in four. In one patient flecainide was administered together with amiodarone and propranolol, and in another patient was used combined with amiodarone. During follow- up with an average time of 12.2 months (median 9.75 months, range 1-28 months), sinus rhythm alternating with slow junctional tachycardia was successfully achieved in 3 patients; no side effects were detected. There was only one death in our study group. The combination of different antiarrhythmics (amiodarone plus propranolol, and eventually flecainide) is a valid option for rhythm control and management of JET in infants.

Diseño de un registro multicéntrico para evaluar control de ritmo contra control de la frecuencia en fibrilación auricular: Registro Mexicano de Fibrilación Auricular (ReMeFA) / Design of a multicenter registry to evaluate rhythm versus rate control in atrial fibrillation: Atrial Fibrillation Mexican Registry (ReMeFA)

La fibrilación auricular es una arritmia muy frecuente y afecta predominantemente a individuos mayores de 70 años. Se dispone de poca información sobre su manejo en México por lo que se diseñó el Registro Mexicano de Fibrilación Auricular (ReMeFA). Método: Se trata de un estudio multicéntrico, observacional, prospectivo sobre el tratamiento de la fibrilación auricular. Se incluyeron sujetos de ambos géneros, mayores de 18 años de edad, con fibrilación auricular documentada. Se excluyeron aquellos con fibrilación auricular secundaria a una causa reversible, sometidos a ablación de venas pulmonares (quirúrgica o por catéter), portadores de marcapasos o desfibriladores, aquellos con expectativa de vida menor a un año o incapacitados física o mentalmente para cumplir con los requisitos del protocolo. Se recolectaron datos clínicos y demográficos en forma basal y en visitas programadas a los seis y doce meses. Especialmente, se recabó información acerca del tratamiento farmacológico para control del ritmo o de la frecuencia. Resultados preliminares: Entre el ocho de diciembre y el 29 de julio de 2009 se incluyeron 1201 pacientes provenientes de 79 centros, con diagnóstico de fibrilación auricular. Conclusión: El registro proporcionará información valiosa sobre las estrategias actualmente empleadas en la República Mexicana para el tratamiento de la fibrilación auricular, sea mediante control del ritmo o control de la frecuencia.

Atrial fibrillation is the most common arrhythmia, predominantly affecting individuals older than 70 years of age. There is little information about its management in Mexico, for this purpose the Mexican Registry of Atrial Fibrillation (ReMeFa) was designed. Methods: ReMeFA is a prospective multicentric, observational registry concerning the treatment of atrial fibrillation in Mexico. It includes patients 18 years and older, from both genders, with documented atrial fibrillation. Patients with secondary atrial fibrillation from a reversible cause, previous treatment with pulmonary vein ablation (percutaneous or surgical), pacemakers or defibrillators, and with a life expectancy of less than one year, physically or mentally impaired for completing the protocol were excluded. Clinical and demographic data were collected at enrollment and in two scheduled visits at 6 and 12 months. Information about pharmacologic treatment for rhythm or rate control was particularly obtained. Preliminary results: Between December 2008 to July 2009, 1201 patients from 79 centers were enrolled. Conclusion: This registry will provide valuable information about the strategy chosen by physicians in Mexico for the treatment of atrial fibrillation.

Use of antiarrhythmic drugs in elderly patients / 老年心脏病学杂志（英文版）

Human aging is a global issue with important implications for current and future incidence and prevalence of health conditions and disability.Cardiac arrhythmias,including atrial fibrillation,sudden cardiac death,and bradycardia requiring pacemaker placement,all increase exponentially after the age of 60.It is important to distinguish between the normal,physiological consequences of aging on cardiacelectrophysiology and the abnormal,pathological alterations.The age-related cardiac changes include ventricular hypertrophy,senileamyloidosis,cardiac valvular degenerative changes and annular calcification,fibrous infiltration of the conduction system,and loss of naturalpacemaker cells and these changes could have a profound effect on the development of arrhythmias.The age-related cardiac electrophysiological changes include up- and down-regulation of specific ion channel expression and intracellular Ca2+ overload which promote the development of cardiac an-hythmias.As ion channels are the substrates of antiarrhythmic drugs,it follows that the pharmacoldnetics and pharmacodynamics of these drugs will also change with age.Aging alters the absorption,distribution,metabolism,and elimination of antiarrhythmic drugs,so liver and kidney function must be monitored to avoid potential adverse drug effects,and antiarrhythmic dosing may need to be adjusted for age.Elderly patients are also more susceptible to the side effects of many antiarrhythmics,including bradycardia,orthostatic hypotension,urinary retention,and falls.Moreover,the choice of antiarrhythmic drugs in the elderly patient is frequently complicated by the presence of co-morbid conditions and by polyphanmacy,and the astute physician must pay careful attention to potential drug-drug interactions.Finally,it is important to remember that the use of antiarrhythmic drugs in elderly patients must be individualized and tailored to each patient's physiology,disease processes,and medication regimen.

Drug Therapy and Catheter Ablation for Atrial Fibrillation

In all clinical trials comparing rate versus rhythm control of atrial fibrillation (AF) by drugs, there was no survival benefit associated with a rhythm control strategy. Currently used antiarrhythmic drugs are not only frequently ineffective at eliminating AF, but may be life threatening in some patients. Catheter ablation (CA) of AF has evolved rapidly and has become accepted as one of the therapeutic modalities for controlling AF. The effective strategies for CA of AF consist of pulmonary vein isolation (PVI) and/or complete encirclement around PVs with or without additional ablation lines. Selection of patients, who may be benefited by CA or not, is an important issue. Precise electroanatomic mapping for the triggers and the substrate of the atria is central for customizing ablation target and for enhancing efficacy of CA for AF. With further development of new energy sources of ablation, cardiac imaging, navigation, and mapping systems, the CA can be simplified and standardized, which may enable the CA to become more effective, safer, and more applicable to many different subsets of AF.

Pharmacoepidemiological Studies on Evaluation and Promotion of the Rational Use of Antiarrhythmic Drugs / 薬剤疫学

To evaluate and promote the rational use of antiarrhythmic drugs, a series of pharmacoepidemiological studies were performed. First, studies on hypoglycemia induced by cibenzoline were performed. The mechanism of the hypoglycemic effect of cibenzoline is related to an increase in insulin secretion. A significantly increased risk of hypoglycemia was observed in patients treated with cibenzoline in a case-controlled study. In particular, close attention should be paid to the occurrence of cibenzoline-induced hypoglycemia in elderly patients, those receiving high doses and in those with reduced renal function. After the introduction of TDM, the risk of hypoglycemia associated with cibenzoline use decreased together with an increase of the percentage of patients whose serum concentrations of cibenzoline had been measured. Dose adjustment based on TDM was beneficial for patients treated with cibenzoline in order to prevent hypoglycemia. In general, drugs are used in accordance with an approved dosage regimen in the expectation of an appropriate balance between efficacy and toxicity. However, a difference was seen between the approved dosage and the actual dose in cibenzoline therapy. Secondly, prescription research of several antiarrhythmic drugs was performed at five national hospitals. Antiarrhythmic drugs were used in lower doses than the approved dosage in clinical practice in Japan. Differences were seen between the approved dosage and the actual dose, and remarkable variations were seen in the dose distribution among the hospitals. The discrepancy between the approved dosage and practical dosage suggests that there is doubt as to whether the approved dosing regimens for antiarrhythmic drugs are appropriate.

Satisfaction in use examination results for computer-assisted instruction on antiarrhythmic drugs.

Computer-assisted instruction (CAI) has become a modern tool for self-instruction in subjects that were once thought to be erudite. We have used CAI in teaching several topics of pharmacology to third year medical students since 1995. In 1996, we developed CAI in antiarrhythmic drugs by using the software ToolBook, version 3.0, comprising 29 electronic pages. Most pages contain English text, drawn images, animation and sound effects. To minimize the size of CAI, no scanned images or video clips were used. Some preliminary explanations were given before the class was held to enable the students to use CAI as provided. Subjective satisfaction after using CAI was evaluated from questionnaire answered immediately after the examination. An objective evaluation was made from the number of correct answers to eight antiarrhythmic questions in the third sectional examination (which contained 85 questions). From the questionnaire, the students are divided into two groups. The first group comprised 83 questions who had never used CAI; the second group contained 123 students who had used it at least once. The mean number of correct answers+SD to the antiarrhythmic questions in the first and the second groups were 3.60+1.51 and 4.14+1.73, respectively, which shows a atatistically significant difference (P<0.01) despite the similarity of the original scores in the first two exams (70.27+8.85 percent and 70.57+9.81 percent, respectively. CAI therefore helps to increase the number of correct answers to antiarrhythmic questions, even though the increase is small. The difference may have resulted from including two students who answered all the questions wrong and another student who answered all the questions correctly in the second group as well as English being the only language used in CAI.

Fibrilação atrial aguda na unidade de emergência: qual a droga ideal para rápida reversäo ao ritmo sinusal? / Acute Atrial Fibrillation. Which is the Best Drug for Sinus Rhythm Conversion in the Emergency Room ?

Objetivo - Comparar o tempo e o índice de sucesso para reversäo da fibrilaçäo atrial (FA) aguda, com o uso de amiodarona, procainamida ou quinidina. Métodos - Aleatoriamente, 60 pacientes com FA aguda foram divididos em três grupos, recebendo o grupo quinidina (GQ), constituído de 21 pacientes, digital EV + quinidina até 600mg VO; o grupo procainamida (GP) com 23 pacientes, digital EV + 10mg/kg de procainamida EV e o grupo amiodarona (GA), com 16 pacientes 5mg/kg de amiodarona EV. O período de observaçäo foi de no máximo 4h, através de Holter. Na análise estatíca foi utilizado o teste de x2 com o método de Kruskall-Wallis, considerando-se significativo p<0,05. Resultados - Os três grupos foram similares quanto a idade, sexo e tempo de instalaçäo da FA. A reversäo ocorreu em 71,4 por cento dos casos no GQ, em 47,8 por cento no GP e em 50 por cento no GA, (p>0,05). O tempo para reversäo em minutos foi de 112 + ou - 43 no G!, de 44,1 + ou - 28 no GP, de 20 + ou - 13 no GA, sendo menor e estatisticamente significante no GP e, principalmente, no GA (p= 0,001) em relaçäo ao GQ. Os efeitos colaterais foram mais freqüentes no GP, embora sem significância estatística. Conclusäo - A amiodarona, especialmente na ausência de cardiopatia de base, é uma boa opçäo para maior rapidez na reversäo da FA, enquanto a quinidina propicia maior taxa de reversäo, com menos efeitos colaterais

Inhibitory Effects of Cicletanine and Bepridil on the Contractions of Isolated Rat Thoracic Aorta Rings / 第二军医大学学报

The inhibitory effects of cicletanine (Cic) and bepridil (Bep) on norepinephrine (NE)-and KCl-induced contractions were studied in isolated thoracic aorta rings of male Sprague-Dowley rats. It was found that Cic had a more potent effect on NE-induced contraction than on KCHnduced contraction. In. contrast, Bep had a more potent action on KCHnduced contraction. When the aorta rings were incubated with Cic and Bep, a potentialized inhibitory effect was observed on KCh but not NE-induced contractions. These effects were independent of the presence of endothelium. The results suggest that Cic and Bep have different action sites and properties on vascular smooth muscles.