Levy S
Department of Cardiology, Hôpital Nord, University of Aix, Marseille, France.
Drugs. 1991;41 Suppl 2:47-53. doi: 10.2165/00003495-199100412-00007.
The antiarrhythmic properties of amiodarone at the ventricular level were discovered in the early 1970s. The unanimously recognised efficacy of amiodarone includes a weak negative inotropic effect and compensatory vasodilatory properties, making amiodarone particularly suitable for treating the potentially malignant arrhythmias associated with organic disease. In a review of 611 hospitalised patients on amiodarone, and 353 patients in whom the drug had been prescribed, over a 52-month period in our 60-bed department, we noted that amiodarone was prescribed in 53% of patients for arrhythmias and in 47% of patients for coronary insufficiency. Ventricular arrhythmias represented 13% of the rhythmic indications. These indications differ from those in the USA. The efficacy (70 to 90%) of amiodarone in ventricular extrasystoles has been shown in open studies. In coronary patients, the antiarrhythmic activity of amiodarone is superior to that of propranolol. However, there has been no controlled study because the need for a loading dosage, and the electrocardiographic effects render such studies difficult. After myocardial infarction, ventricular arrhythmias constitute a significant risk factor independently of prognosis; amiodarone may be useful in this indication, and studies of the European Myocardial Infarction Amiodarone Trial (EMIAT) type will examine its value here. Since 1973, it has been recognised that amiodarone can prevent ventricular tachycardia in 55 to 89% of patients in the clinical situation. After a long-standing controversy, the positive predictive value of programmed stimulation has finally been agreed on. In hypertrophic cardiomyopathy, retrospective studies suggest a reduction in mortality in patients treated with amiodarone. By contrast, the value of amiodarone in dilated cardiomyopathy requires more intensive investigation. We consider amiodarone to be indicated in ventricular arrhythmic complexes, particularly if they are associated with an ejection fraction of less than 35% and/or atrial fibrillation. The value of amiodarone in arrhythmias associated with heart failure needs to be evaluated. In conclusion, amiodarone is a powerful antiarrhythmic agent but, because of the possibility of dose- and duration-dependent side effects, evaluation of the risk: benefit ratio in each indication is needed.
胺碘酮在心室水平的抗心律失常特性于20世纪70年代初被发现。胺碘酮被一致认可的疗效包括微弱的负性肌力作用和代偿性血管舒张特性，这使得胺碘酮特别适用于治疗与器质性疾病相关的潜在恶性心律失常。在我们拥有60张床位的科室进行的一项为期52个月的研究中，对611名住院使用胺碘酮的患者以及353名开具了该药物的患者进行了回顾，我们注意到53%的患者因心律失常而使用胺碘酮，47%的患者因冠状动脉供血不足而使用。室性心律失常占节律性适应证的13%。这些适应证与美国的不同。开放研究表明胺碘酮对室性期前收缩的疗效为70%至90%。在冠心病患者中，胺碘酮的抗心律失常活性优于普萘洛尔。然而，由于需要负荷剂量以及心电图效应，使得此类对照研究很困难。心肌梗死后，室性心律失常是独立于预后的重要危险因素；胺碘酮可能对此适应证有用，欧洲心肌梗死胺碘酮试验（EMIAT）类型的研究将在此评估其价值。自1973年以来，人们已经认识到胺碘酮在临床情况下可使55%至89%的患者预防室性心动过速。经过长期的争论，程序刺激的阳性预测价值最终得到了认可。在肥厚型心肌病中，回顾性研究表明使用胺碘酮治疗的患者死亡率降低。相比之下，胺碘酮在扩张型心肌病中的价值需要更深入的研究。我们认为胺碘酮适用于室性心律失常复合体，特别是当它们与射血分数低于35%和/或心房颤动相关时。胺碘酮在与心力衰竭相关的心律失常中的价值需要评估。总之，胺碘酮是一种强大的抗心律失常药物，但由于可能存在剂量和疗程依赖性副作用，需要评估每种适应证的风险：获益比。
