Singh S N, Fletcher R D
Veterans Affairs Medical Center, Washington, DC 20422, USA.
Am J Cardiol. 1999 Nov 4;84(9A):103R-108R. doi: 10.1016/s0002-9149(99)00710-9.
Patients with congestive heart failure frequently have ventricular arrhythmias on ambulatory electrocardiographic recordings and sudden cardiac death is seen in almost 50% of such patients. Many antiarrhythmic agents have been approved to suppress the arrhythmia in an effort to improve survival. Some sodium-channel blockers not only failed to improve survival but have been shown to be harmful. This led to the development of potassium-channel blockers, such as d-sotalol, amiodarone, dofetilide, and azimilide. d-Sotalol was associated with excess mortality in patients with left ventricular dysfunction; amiodarone seems to be potentially beneficial; and dofetilide has a neutral effect on mortality. The Sudden Cardiac Death Heart Failure Trial (SCD HEFT) is testing the implantable cardioverter defibrillator (ICD) against amiodarone and placebo. The ICDs appear to be superior to antiarrhythmic drugs in certain high-risk patients, although not proved in unstratified patients with heart failure.
充血性心力衰竭患者在动态心电图记录中常出现室性心律失常，近50%的此类患者会发生心源性猝死。许多抗心律失常药物已被批准用于抑制心律失常，以提高生存率。一些钠通道阻滞剂不仅未能提高生存率，还被证明是有害的。这促使了钾通道阻滞剂的研发，如d - 索他洛尔、胺碘酮、多非利特和阿齐利特。d - 索他洛尔与左心室功能不全患者的死亡率增加有关；胺碘酮似乎有潜在益处；多非利特对死亡率有中性影响。心脏性猝死心力衰竭试验（SCD HEFT）正在对比植入式心脏复律除颤器（ICD）、胺碘酮和安慰剂的效果。在某些高危患者中，ICD似乎优于抗心律失常药物，尽管在未分层的心力衰竭患者中尚未得到证实。
