Schrickel Jan W, Schwab Joerg O, Yang Alexander, Bitzen Alexander, Lüderitz Berndt, Lewalter Thorsten
Department of Medicine/Cardiology, University of Bonn, Bonn, Germany.
Pacing Clin Electrophysiol. 2006 Apr;29(4):363-6. doi: 10.1111/j.1540-8159.2006.00354.x.
Amiodarone is one of the most efficient and safe antiarrhythmic drugs in the treatment of atrial fibrillation (AF). Yet, though rare, proarrhythmic effects remain a clinical problem. We present three cases of amiodarone-associated "Torsade de pointes" tachycardia (Tdp) in patients treated concomitantly with heart rate controlling medication for AF. Amiodarone loading therapy was started for the treatment of tachyarrhythmic AF in all the three patients. All presented with a history of coronary heart disease, resulting in a severely reduced left ventricular ejection fraction in two patients. One received oral amiodarone loading, in the others, amiodarone was administered intravenously because of hemodynamically relevant AF episodes. Amiodarone therapy was combined with a heart rate controlling medication including a beta-blocking agent and digitalis in all the cases. All the subjects suffered from clinically relevant Tdp in the early run after initiation of amiodarone loading (max. 48 hours). The mean QTc in all patients before induction of Tdp was prolonged. The present case reports imply that amiodarone in combination with beta-blocker/digitalis therapy may be associated with an elevated proarrhythmic risk in selected patients with structural heart disease and AF.
胺碘酮是治疗心房颤动（AF）最有效且安全的抗心律失常药物之一。然而，尽管罕见，但促心律失常作用仍是一个临床问题。我们报告了3例在接受AF心率控制药物治疗的患者中发生的与胺碘酮相关的尖端扭转型室性心动过速（Tdp）。所有3例患者均开始采用胺碘酮负荷疗法治疗快速心律失常性AF。所有患者均有冠心病病史，其中2例患者左心室射血分数严重降低。1例接受口服胺碘酮负荷治疗，另外2例因血流动力学相关的AF发作接受静脉注射胺碘酮治疗。所有病例中，胺碘酮治疗均联合了包括β受体阻滞剂和洋地黄在内的心率控制药物。所有受试者在胺碘酮负荷治疗开始后的早期（最长48小时）均出现了临床相关的Tdp。所有患者在诱发Tdp前的平均QTc均延长。本病例报告提示，在患有结构性心脏病和AF的特定患者中，胺碘酮联合β受体阻滞剂/洋地黄治疗可能会增加促心律失常风险。
