Borggrefe M, Haverkamp W, Shenasa M, Hindricks G, Breithardt G
Department of Cardiology and Angiology, Westf, Wilhelms-University Münster, Germany.
J Cardiovasc Pharmacol. 1992;20 Suppl 2:S32-40.
Ventricular tachycardia and ventricular fibrillation are frequent complications of organic heart disease. There is sufficient evidence that serial electrophysiologic testing is able to predict long-term efficacy of antiarrhythmic agents in patients with malignant ventricular tachyarrhythmias. This approach has not only been useful for the evaluation of class I drugs, but recent studies have shown that this invasive method may also be useful for the management of patients undergoing treatment with class III antiarrhythmic agents such as amiodarone and sotalol. The results of several studies suggest that class III agents are more effective than class I drugs in patients presenting with ventricular tachycardia or ventricular fibrillation. Proarrhythmic complications in patients treated with class III antiarrhythmic drugs are mainly characterized by torsades de pointes. Their incidence does not exceed 5%. Further studies are necessary to elucidate the mechanisms underlying this type of proarrhythmia. By the use of currently available stimulation techniques, patients who might develop torsades de pointes while on therapy with a class III agent cannot be identified.
室性心动过速和心室颤动是器质性心脏病常见的并发症。有充分证据表明，系列电生理检查能够预测抗心律失常药物对恶性室性心律失常患者的长期疗效。这种方法不仅对Ⅰ类药物的评估有用，而且最近的研究表明，这种侵入性方法对接受Ⅲ类抗心律失常药物（如胺碘酮和索他洛尔）治疗的患者的管理也可能有用。多项研究结果表明，Ⅲ类药物在出现室性心动过速或心室颤动的患者中比Ⅰ类药物更有效。接受Ⅲ类抗心律失常药物治疗的患者的促心律失常并发症主要表现为尖端扭转型室性心动过速。其发生率不超过5%。需要进一步研究以阐明这类促心律失常的潜在机制。使用目前可用的刺激技术，无法识别在接受Ⅲ类药物治疗时可能发生尖端扭转型室性心动过速的患者。
