Burckhardt D, Hoffmann A, Kiowski W, Pfisterer M, Burkart F
Division of Cardiology, University Hospital Basel, Switzerland.
J Cardiovasc Pharmacol. 1991;17 Suppl 6:S77-81.
In an attempt to improve survival of patients with coronary artery disease and high-grade ventricular ectopic activity, several studies using different antiarrhythmic drugs were undertaken. A meta-analysis of all randomized controlled trials using type I antiarrhythmic agents showed that the treatment effect was much more likely to be adverse than beneficial. In contrast to these studies, the pooled results of major secondary prevention trials using beta-blocking agents could demonstrate a significant reduction in the sudden death rate by an average of 24% during observation periods of 9-36 months. In the beta-blocker trials, however, patients with contraindications for this type of drug, such as overt congestive heart failure or chronic obstructive lung disease, were excluded. In these patients a type III antiarrhythmic drug, such as amiodarone, may have a place, and in fact, the Basel Antiarrhythmic Study of Infarct Survival, a prospective, controlled, randomized trial using low-dose amiodarone as an antiarrhythmic agent, could demonstrate a 60% reduction in sudden death rate and a 74% reduction in arrhythmic events incidence during the first year after myocardial infarction. Therefore, in patients with repetitive ventricular ectopic activity after myocardial infarction and adequate left ventricular function, a therapeutic attempt with beta-blockers without intrinsic sympathomimetic activity seems advisable. Beside beta-adrenergic blockade, low-dose amiodarone is an alternative, especially in patients with impaired left ventricular function or other contraindications for beta-blockers.
为了提高冠心病合并高度室性异位活动患者的生存率，开展了多项使用不同抗心律失常药物的研究。对所有使用I类抗心律失常药物的随机对照试验进行的荟萃分析表明，治疗效果更可能是有害而非有益的。与这些研究不同，使用β受体阻滞剂的主要二级预防试验的汇总结果显示，在9至36个月的观察期内，猝死率平均显著降低24%。然而，在β受体阻滞剂试验中，排除了对此类药物有禁忌证的患者，如明显的充血性心力衰竭或慢性阻塞性肺疾病患者。在这些患者中，III类抗心律失常药物，如胺碘酮，可能有一席之地，事实上，以低剂量胺碘酮作为抗心律失常药物的前瞻性、对照、随机试验——巴塞尔心肌梗死存活抗心律失常研究，可证明心肌梗死后第一年猝死率降低60%，心律失常事件发生率降低74%。因此，对于心肌梗死后有反复室性异位活动且左心室功能正常的患者，尝试使用无内在拟交感活性的β受体阻滞剂进行治疗似乎是可取的。除了β肾上腺素能阻滞作用外，低剂量胺碘酮是一种替代选择，尤其是对于左心室功能受损或有β受体阻滞剂其他禁忌证的患者。
