Eur Heart J. 1991 Oct;12(10):1112-31.
The Queen's Gambit is an opening move in chess that provides a variety of aggressive options to the player electing it. This report represents a similar gambit (the 'Sicilian Gambit') on the part of a group of basic and clinical investigators who met in Taormina, Sicily, to consider the classification of antiarrhythmic drugs. Paramount to their considerations were (1) dissatisfaction with the options offered by existing classification systems for inspiring and directing research, development and therapy, (2) the disarray in the field of antiarrhythmic drug development and testing in this post-CAST era, and (3) the desire to provide an operational framework for consideration of antiarrhythmic drugs that will both encourage advancement and have the plasticity to grow as a result of the advances that occur. The multifaceted approach suggested is, like the title of the manuscript, a gambit. It is an opening rather than a compendium, and is intended to challenge thought and investigation rather than to resolve issues. The manuscript incorporates first, a discussion of the shortcomings of the present system for drug classification; second, a review of the molecular targets on which drugs act (including channels and receptors); third, a consideration of the mechanisms responsible for arrhythmias, including the identification of 'vulnerable parameters' that might be most accessible to drug effect; and finally, clinical considerations with respect to antiarrhythmic drugs. Information relating to the various levels of information is correlated across categories (i.e., clinical arrhythmias, cellular mechanisms and molecular targets), and a 'spread sheet' approach to antiarrhythmic action is presented that considers each drug as a unit, with similarities to and dissimilarities from other drugs being highlighted. A complete reference list for this work would require as many pages as the text itself. For this reason, referencing is selective and incomplete. It is designed, in fact, to provide sufficient background information to give the interested reader a starting frame of reference, rather than to recognize the complete body of literature that is the basis for this paper.
“后翼弃兵”是国际象棋中的一种开局着法，为选择此着法的棋手提供了多种进攻选择。本报告代表了一组基础和临床研究人员采取的类似弃兵策略（“西西里弃兵”），他们在西西里岛的陶尔米纳会面，探讨抗心律失常药物的分类。他们考虑的首要因素包括：（1）对现有分类系统在启发和指导研究、开发及治疗方面所提供的选择不满意；（2）在CAST时代之后抗心律失常药物研发和测试领域的混乱状况；（3）希望提供一个可操作的框架来考量抗心律失常药物，既能鼓励进步，又能因出现的进展而具有发展的灵活性。所建议的多方面方法，如同手稿的标题一样，是一种弃兵策略。它是一个开端而非汇编，旨在激发思考和研究，而非解决问题。手稿首先讨论了当前药物分类系统的缺点；其次回顾了药物作用的分子靶点（包括通道和受体）；第三考量了心律失常的发生机制，包括识别可能最易受药物作用影响的“敏感参数”；最后是关于抗心律失常药物的临床考量。与各个信息层面相关的信息在不同类别（即临床心律失常、细胞机制和分子靶点）之间相互关联，并呈现了一种“电子表格”式的抗心律失常作用方法，将每种药物视为一个单元，突出其与其他药物的异同。这项工作的完整参考文献列表所需篇幅将与正文本身一样多。因此，参考文献是有选择性的且不完整。实际上，其目的是提供足够的背景信息，为感兴趣的读者提供一个起始参考框架，而非列举构成本文基础的全部文献。
