Fogel R I, Herre J M, Kopelman H A, Kowey P R, Trohman R G, Fineberg N, Prystowsky E N
Northside Cardiology PC, Indianapolis, IN 46260, USA.
Am Heart J. 2000 Apr;139(4):690-5. doi: 10.1016/s0002-8703(00)90049-8.
Intravenous amiodarone is effective for the acute suppression of recurrent hemodynamically destabilizing ventricular arrhythmias. There are no follow-up data on patients undergoing long-term therapy with intravenous amiodarone. The objective of this investigation was to evaluate long-term outcome.
We reviewed the clinical courses of 245 patients given intravenous amiodarone for sustained ventricular tachyarrhythmias. Of the 107 survivors (84% men; mean age 64 years) released from the hospital taking oral amiodarone, 41 were discharged with an empiric prescription for oral amiodarone. For 64 patients a decision regarding further therapy was based on results of an electrophysiologic study. Two patients were treated empirically with oral amiodarone and an implantable cardioverter defibrillator. Clinical variables and survival curves were the same for the empirically treated group and the group whose treatment was based on electrophysiologic findings (P =.89). Survival at 6, 12, and 18 months was 88%, 81% and 71%, respectively, for empirically treated patients, and 83%, 80% and 73%, respectively, for patients whose therapy was directed with an electrophysiologic study. Of the 64 patients who underwent electrophysiologic studies, 33 received an implantable cardioverter defibrillator. The Kaplan-Meier survival curves for patients with and patients without an implantable cardioverter defibrillator were similar (P =.46).
Patients for whom recurrent ventricular tachycardia and fibrillation are suppressed with intravenous amiodarone and who are discharged receiving oral amiodarone have an 80% 1-year survival rate. Although not randomized, our data suggested that among such patients, electrophysiologic testing, implantation of a cardioverter defibrillator, or both may not be necessary. Ascertaining the best management strategy for these patients will require a prospective randomized trial.
静脉注射胺碘酮对急性抑制反复出现的血流动力学不稳定的室性心律失常有效。目前尚无关于接受静脉胺碘酮长期治疗患者的随访数据。本研究的目的是评估长期疗效。
我们回顾了245例因持续性室性快速心律失常接受静脉胺碘酮治疗患者的临床病程。107例存活患者（84%为男性；平均年龄64岁）出院时服用口服胺碘酮，其中41例出院时接受了口服胺碘酮的经验性处方。对于64例患者，进一步治疗的决策基于电生理研究结果。2例患者接受了口服胺碘酮和植入式心脏复律除颤器的经验性治疗。经验性治疗组和基于电生理检查结果进行治疗的组的临床变量和生存曲线相同（P = 0.89）。经验性治疗患者6个月、12个月和18个月的生存率分别为88%、81%和71%，而基于电生理研究进行治疗的患者分别为83%、80%和73%。在接受电生理研究的64例患者中，33例接受了植入式心脏复律除颤器。有和没有植入式心脏复律除颤器患者的Kaplan-Meier生存曲线相似（P = 0.46）。
静脉注射胺碘酮抑制反复出现的室性心动过速和颤动并出院后接受口服胺碘酮治疗的患者1年生存率为80%。尽管未进行随机分组，但我们的数据表明，在此类患者中，可能无需进行电生理检查、植入心脏复律除颤器或两者同时进行。确定这些患者的最佳管理策略需要进行前瞻性随机试验。
