Podrid P J, Beau S L
Department of Medicine, Boston University Medical School, Massachusetts.
Am J Cardiol. 1990 Feb 20;65(8):56D-64D; discussion 68D-71D. doi: 10.1016/0002-9149(90)91419-7.
Many patients who have serious ventricular arrhythmia requiring antiarrhythmic drug therapy have congestive heart failure (CHF). However, the pharmacokinetic and pharmacodynamic properties of the antiarrhythmic drugs are altered in the presence of CHF. It has been reported that some adverse effects, primarily aggravation of arrhythmia and CHF occur more frequently in patients with a history of left ventricular (LV) dysfunction. Moreover, antiarrhythmic drugs are less effective in patients with a history of CHF and a reduced LV ejection fraction (LVEF). Moricizine, a new antiarrhythmic drug, has been undergoing clinical trials for over 13 years in the United States. The data base involving 1,072 patients was analyzed to establish the effect of this agent in patients with CHF. The presence of CHF does not alter the absorption, half-life and clearance of moricizine. The incidence of CHF exacerbation definitely related to moricizine was low (2%) and occurred primarily in patients with a history of CHF. Aggravation of arrhythmia and conduction abnormalities also occurred more often in patients with prior CHF. However, the incidence of all other adverse effects involving other organ systems was the same in patients with and without CHF and was also unrelated to the baseline LVEF. The effect of moricizine for suppressing spontaneously occurring ventricular ectopy was also similar in patients with and without CHF and was independent of LVEF. However, the drug is less effective in preventing sustained ventricular arrhythmia in patients with CHF.
许多患有严重室性心律失常且需要抗心律失常药物治疗的患者同时患有充血性心力衰竭（CHF）。然而，在存在CHF的情况下，抗心律失常药物的药代动力学和药效学特性会发生改变。据报道，一些不良反应，主要是心律失常和CHF的加重，在有左心室（LV）功能障碍病史的患者中更频繁地发生。此外，抗心律失常药物在有CHF病史且左心室射血分数（LVEF）降低的患者中效果较差。莫雷西嗪是一种新型抗心律失常药物，在美国已经进行了超过13年的临床试验。对涉及1072名患者的数据库进行了分析，以确定该药物对CHF患者的疗效。CHF的存在并未改变莫雷西嗪的吸收、半衰期和清除率。与莫雷西嗪明确相关的CHF恶化发生率较低（2%），主要发生在有CHF病史的患者中。心律失常和传导异常的加重在既往有CHF的患者中也更常发生。然而，涉及其他器官系统的所有其他不良反应的发生率在有CHF和无CHF的患者中相同，并且也与基线LVEF无关。莫雷西嗪抑制自发性室性早搏的效果在有CHF和无CHF的患者中也相似，并且与LVEF无关。然而，该药物在预防CHF患者的持续性室性心律失常方面效果较差。
