Frank M J, Watkins L O, Prisant L M, Smith M S, Russell S L, Abdulla A M, Manwaring R L
Department of Medicine, Medical College of Georgia, Augusta.
J Clin Pharmacol. 1991 Mar;31(3):222-8. doi: 10.1002/j.1552-4604.1991.tb04965.x.
The efficacy of mexiletine and quinidine in controlling ventricular couplets (VC) and ventricular tachycardia (VT) was compared in 156 trials (78 for each drug) in 114 consecutive patients. Forty-two patients received both drugs, whereas 36 patients were given mexiletine, and 36 patients received quinidine only. During acute drug testing, mexiletine was more effective than quinidine in controlling VC and VT (54 vs. 32 patients, respectively, P less than .001) and resulted in fewer proarrhythmic events (4 vs. 13, respectively, P less than .05). Mean duration of follow-up for mexiletine (27 +/- 14 mo) and quinidine (21 +/- 14 mo) did not differ. Long-term success was more frequent with mexiletine administration than quinidine administration (33/47 vs. 10/30 patients, respectively, P less than .01). The incidence of sudden death during follow-up with the two drugs did not differ overall, but more patients with ejection fraction greater than or equal to 40% died suddenly while taking quinidine than while receiving mexiletine (4/17 vs. 0/24, P less than .02). Mexiletine is as effective as quinidine for treating VC and VT and appears to be less proarrhythmic. It should be considered as an initial choice in the management of VC and VT.
在114例连续患者中进行了156次试验（每种药物78次），比较了美西律和奎尼丁控制室性二联律（VC）和室性心动过速（VT）的疗效。42例患者接受了两种药物治疗，36例患者服用美西律，36例患者仅接受奎尼丁治疗。在急性药物测试期间，美西律在控制VC和VT方面比奎尼丁更有效（分别为54例和32例患者，P＜0.001），且致心律失常事件更少（分别为4例和13例，P＜0.05）。美西律（27±14个月）和奎尼丁（21±14个月）的平均随访时间无差异。美西律给药的长期成功率高于奎尼丁给药（分别为33/47例和10/30例患者，P＜0.01）。两种药物随访期间猝死的发生率总体无差异，但射血分数大于或等于40%的患者在服用奎尼丁时猝死的人数多于服用美西律时（4/17例 vs. 0/24例，P＜0.02）。美西律在治疗VC和VT方面与奎尼丁同样有效，且似乎致心律失常作用较小。在VC和VT的治疗中应将其视为初始选择。
