약제 관련 서맥의 임상 경과 = Clinical Course of the Drug-related Bradyarrhythmias

국문 초록 (Abstract)

배경 및 목적: 최근 약물과 관련되어 발생한 서맥성 부정맥의 예후에 대한 재평가가 이루어지고 있다. 본 연구는 약제 유발성 서맥으로 최초 진단받은 환자들의 임상 경과를 분석하여 그 예후를 평가하고자 하였다. 방법: 전북대학교 병원 심장내과에 2000년 1월 이후 약물 유발성 서맥으로 진단 받고 입원치료를 받았던 환자들을 대상으로 하여 의무기록 분석 및 전화상담을 통한 후향적 조사를 하였다 결과: 전체 환자 중 경과 관찰 기간 동안 영구적 심박동기 삽입술을 시행 받은 환자는 28명(26.9%)으로, 동기능 부전 증후군 군과 고도방실차단 군에서 각각 15명(/68, 22.1%)과 13명(/36, 36.1%)이었다 결론: 고전적으로 양호한 임상경과를 취하는 것으로 알려져 왔던 이차성 서맥성 부정맥 환자 상당수에서 유발인자가 없이도 서맥이 점차 진행하여 결국 영구형 인공심박동기 이식시술을 받게 된다.

다국어 초록 (Multilingual Abstract)

Background and Objectives: Recently, the prognosis of drug-induced bradyarrhythmias has been reported not as benign as previous considerations. We performed the investigations about the patients who had been diagnosed as drug-related bradyarrhythmias presenting it at first. Subjects and Methods: Medical records of those who had been admitted to Chonbuk National University Hospital due to drug-related bradyarrhythmias since January 2000 were investigated retrospectively and clinical follow-up was performed using phone call. Results: One hundred and four patients were enrolled. Mean age was 68±10(34-85) years. Underlying diseases that need relating drugs were hypertension (50, 48.1%), ischemic heart disease, atrial fibrillation, cardiomyopathy, etc. Most common single causative agent was β-blockers (53.0%) and the others were nondihydropyridine calcium channel blockers (18.9%), digoxin (10.6%), antiarrhythmics (9.1%) and herb-medications (3.8%). 68 patients showed sinus node dysfunction (SND, 65.4%) and 36 showed AVB (34.6%). Mean heart rate on admission was 37.0±7.1 beats/minute. Permanent pacemaker implantations were performed in 28 patients (26.9%). Fifteen among them were with SND (15/68, 22.1%), 13 were with AVB (13/36, 36.1%). Conclusion: Unlikely to the general considerations, it would be better to say that drug-related bradyarrhythmias are not drug-induced bradyrrhythmias itself, but unmasked underlying bradyarrythmias in substantial portion of the patients. Very close and cautious clinical monitoring should be performed, especially in patients with AVB.