Fish F A, Gillette P C, Benson D W
Department of Pediatrics, Children's Memorial Hospital, Northwestern University, Chicago, Illinois.
J Am Coll Cardiol. 1991 Aug;18(2):356-65. doi: 10.1016/0735-1097(91)90586-x.
The potential for proarrhythmic responses to the class IC sodium channel-blocking drugs encainide and flecainide has not been well described in young patients. Therefore, data were retrospectively collected from 36 institutions regarding 579 young patients who were administered encainide or flecainide for treatment of supraventricular tachycardias (encainide 86 patients, flecainide 369 patients) or ventricular arrhythmias (encainide 21 patients, flecainide 103 patients) to assess the frequency of proarrhythmia, cardiac arrest and death during therapy (adverse events). The two drugs were similar in regard to efficacy (flecainide 71.4%, encainide 59.8%) and rate of proarrhythmic responses (flecainide 7.4%; encainide 7.5%). However, patients receiving encainide more frequently experienced cardiac arrest (encainide 7.5% vs. flecainide 2.3%, p less than 0.05) or died during treatment (encainide 7.5% vs. flecainide 2.1%, p less than 0.05). Detailed data were provided for 44 patients experiencing one or more adverse events. Patient age, previous drug trials, concomitant therapy and days of inpatient monitoring were similar for patients receiving encainide or flecainide. However, echocardiographic left ventricular shortening before treatment was lower among patients receiving encainide (0.23 +/- 0.09) than among those receiving flecainide (0.34 +/- 0.06, p less than 0.05). Plasma drug concentrations were rarely elevated. Cardiac arrest (12 patients) and deaths (13 patients) occurred predominantly among patients with underlying heart disease, particularly among patients receiving flecainide for supraventricular tachycardia (8.3% vs. 0.3%, p less than 0.001). Fifteen patients with an ostensibly normal heart and normal ventricular function experienced proarrhythmia during treatment for supraventricular tachycardia, but only 3 of the 15 had a cardiac arrest or died. The relatively high incidence of adverse events should be considered when contemplating treatment with encainide or flecainide, particularly among patients with underlying heart disease.
IC类钠通道阻滞剂恩卡胺和氟卡胺对年轻患者致心律失常反应的可能性尚未得到充分描述。因此，我们回顾性收集了36家机构的579例年轻患者的数据，这些患者接受恩卡胺或氟卡胺治疗室上性心动过速（恩卡胺86例，氟卡胺369例）或室性心律失常（恩卡胺21例，氟卡胺103例），以评估治疗期间致心律失常、心脏骤停和死亡（不良事件）的发生率。这两种药物在疗效（氟卡胺71.4%，恩卡胺59.8%）和致心律失常反应率（氟卡胺7.4%；恩卡胺7.5%）方面相似。然而，接受恩卡胺治疗的患者更频繁地发生心脏骤停（恩卡胺7.5% vs.氟卡胺2.3%，p<0.05）或在治疗期间死亡（恩卡胺7.5% vs.氟卡胺2.1%，p<0.05）。为44例发生1次或多次不良事件的患者提供了详细数据。接受恩卡胺或氟卡胺治疗的患者在年龄、既往药物试验、联合治疗和住院监测天数方面相似。然而，治疗前接受恩卡胺治疗的患者超声心动图左心室缩短率（0.23±0.09）低于接受氟卡胺治疗的患者（0.34±0.06，p<0.05）。血浆药物浓度很少升高。心脏骤停（12例）和死亡（13例）主要发生在有基础心脏病的患者中，特别是接受氟卡胺治疗室上性心动过速的患者（8.3% vs. 0.3%，p<0.001）。15例心脏表面正常且心室功能正常的患者在治疗室上性心动过速期间发生致心律失常，但15例中只有3例发生心脏骤停或死亡。在考虑使用恩卡胺或氟卡胺治疗时，应考虑到不良事件的相对高发生率，尤其是在有基础心脏病的患者中。
