Kamath Ganesh S, Mittal Suneet
Al-Sabah Arrhythmia Institute, New York, NY, USA.
Prog Cardiovasc Dis. 2008 May-Jun;50(6):439-48. doi: 10.1016/j.pcad.2007.12.001.
Sudden cardiac death (SCD) accounts for more than 300,000 deaths annually in the United States alone. The utility of antiarrhythmic drugs in survivors of SCD (secondary prevention) is limited because of their incomplete efficacy and long-term toxicity. Efforts to target primary prevention of SCD have focused on left ventricular dysfunction in conjunction with congestive heart failure. Antiarrhythmic drugs are not able to decrease mortality in this patient population either; in fact, certain drugs may actually increase overall mortality. In both primary and secondary prevention patients, only implantable cardioverter-defibrillator implantation is associated with improved survival. Antiarrhythmic drugs like azimilide, dofetilide, sotalol, and amiodarone can be used as adjunct treatment for management of atrial arrhythmias and to decrease implantable cardioverter-defibrillator shocks. There is an unmet need for more effective and less toxic antiarrhythmic medications.
仅在美国，心脏性猝死（SCD）每年导致的死亡人数就超过30万。抗心律失常药物在SCD幸存者（二级预防）中的效用有限，因为其疗效不完全且具有长期毒性。针对SCD一级预防的努力主要集中在伴有充血性心力衰竭的左心室功能障碍。抗心律失常药物在这类患者人群中也无法降低死亡率；事实上，某些药物可能实际上会增加总体死亡率。在一级和二级预防患者中，只有植入式心脏复律除颤器植入与生存率提高相关。阿齐利特、多非利特、索他洛尔和胺碘酮等抗心律失常药物可作为辅助治疗用于管理房性心律失常并减少植入式心脏复律除颤器电击。对于更有效且毒性更低的抗心律失常药物存在未满足的需求。
