Myerburg R J, Kessler K M, Cox M M, Huikuri H, Terracall E, Interian A, Fernandez P, Castellanos A
Department of Medicine, University of Miami School of Medicine, FL 33101.
Circulation. 1989 Dec;80(6):1571-9. doi: 10.1161/01.cir.80.6.1571.
The use of membrane-active antiarrhythmic agents may be complicated by aggravation of existing arrhythmias or development of new drug-induced arrhythmias. Four patients, referred because of out-of-hospital cardiac arrest or symptomatic sustained ventricular tachycardia, were receiving class IC antiarrhythmic agents in an attempt to prevent inducibility of sustained ventricular tachycardia. New or worsening spontaneous arrhythmias developed while they were on flecainide acetate (n = 3) or encainide hydrochloride (n = 1) therapy. Spontaneous runs of rapid nonsustained and sustained ventricular tachycardia developed in two. Increased frequency of premature ventricular contractions and repetitive forms of ventricular ectopic activity developed in one, despite the fact that inducibility of sustained ventricular tachycardia had been prevented. Salvos and nonsustained ventricular tachycardia developed in the fourth patient. Propranolol had failed to prevent inducibility of sustained ventricular tachycardia during previous programmed stimulation studies in three of the four patients, but it reproducibly suppressed drug-induced arrhythmias that appeared only after administration of the IC agents in each patient. Suppression of the proarrhythmic effects by beta-adrenergic blockade suggests a possible interaction of these drugs with autonomic function in the genesis of the observed proarrhythmic effects. Direct pharmacologic control of proarrhythmic drug effects has not previously been reported.
膜活性抗心律失常药物的使用可能会因现有心律失常的加重或新的药物诱导性心律失常的发生而变得复杂。四名因院外心脏骤停或有症状的持续性室性心动过速前来就诊的患者，正在接受ⅠC类抗心律失常药物治疗，试图预防持续性室性心动过速的诱发。在他们接受醋酸氟卡尼（n = 3）或盐酸恩卡尼（n = 1）治疗期间，出现了新的或恶化的自发性心律失常。两名患者出现了快速非持续性和持续性室性心动过速的自发性发作。一名患者尽管持续性室性心动过速的诱发已得到预防，但室性早搏的频率增加且出现了重复性室性异位活动形式。第四名患者出现了成串性和非持续性室性心动过速。在这四名患者中的三名患者之前的程控刺激研究中，普萘洛尔未能预防持续性室性心动过速的诱发，但它可重复性地抑制了仅在每位患者给予ⅠC类药物后出现的药物诱导性心律失常。β肾上腺素能阻滞剂对促心律失常作用的抑制表明，这些药物在观察到的促心律失常作用的发生过程中可能与自主神经功能相互作用。此前尚未报道过对促心律失常药物作用的直接药理学控制。
