Yoshie Koji, Tomita Takeshi, Takeuchi Takahiro, Okada Ayako, Miura Takashi, Motoki Hirohiko, Ikeda Uichi
Department of Cardiovascular Medicine, Shinshu University School of Medicine, Japan.
Department of Cardiovascular Medicine, Shinshu University School of Medicine, Japan.
Int J Cardiol. 2014 Oct 20;176(3):936-40. doi: 10.1016/j.ijcard.2014.08.090. Epub 2014 Aug 27.
Recent guidelines for treating ventricular fibrillation (VF) and ventricular tachycardia (VT) stress class III antiarrhythmic drugs, but some malignant arrhythmias refractory to these agents still occur in clinical practice. The possibility of a new treatment strategy involving lidocaine and amiodarone combination therapy was evaluated.
From September 2008 to September 2013, 62 patients were treated at our hospital with lidocaine. The medical records were retrospectively reviewed. Twenty inappropriate patients were excluded. The remaining 42 patients were analyzed. Patients were divided into two groups according to the effectiveness of lidocaine in terminating refractory ventricular arrhythmias: the effective group.
LVEF was significantly higher in the lidocaine effective (E) group compared to the ineffective (I) group (44±16% vs. 32±10%, p=0.027). There were more patients already on amiodarone at the start of lidocaine therapy in the E group compared to the I group (11/26 vs. 1/16, p=0.012). Furthermore, patients receiving lidocaine without amiodarone were re-analyzed to estimate the actual effect of lidocaine. Of the 30 patients not receiving amiodarone, 15 were in the effective without amiodarone (E w/o A) group and 15 were in the ineffective without amiodarone (I w/o A) group. LVEF was significantly higher in the E w/o A group than in the I w/o A group (51±16% vs. 32±9%, p=0.001).
This retrospective study suggests that combination therapy with lidocaine and amiodarone can terminate most refractory ventricular arrhythmias. Even in patients with a sufficient LVEF not receiving amiodarone, it is possible that lidocaine can contribute to a favorable outcome.
近期治疗心室颤动（VF）和室性心动过速（VT）的指南强调Ⅲ类抗心律失常药物，但临床实践中仍会出现一些对这些药物难治的恶性心律失常。本研究评估了利多卡因和胺碘酮联合治疗这一新治疗策略的可能性。
2008年9月至2013年9月，我院62例患者接受利多卡因治疗。对病历进行回顾性分析。排除20例不适合的患者。对其余42例患者进行分析。根据利多卡因终止难治性室性心律失常的有效性将患者分为两组：有效组。
利多卡因有效（E）组的左心室射血分数（LVEF）显著高于无效（I）组（44±16%对32±10%，p=0.027）。与I组相比，E组在利多卡因治疗开始时已服用胺碘酮的患者更多（11/26对1/16，p=0.012）。此外，对未服用胺碘酮而接受利多卡因治疗的患者进行重新分析，以评估利多卡因的实际效果。在30例未服用胺碘酮的患者中，15例属于未服用胺碘酮有效（E w/o A）组，15例属于未服用胺碘酮无效（I w/o A）组。E w/o A组的LVEF显著高于I w/o A组（51±16%对32±9%，p=0.001）。
这项回顾性研究表明，利多卡因和胺碘酮联合治疗可终止大多数难治性室性心律失常。即使在左心室射血分数充足且未服用胺碘酮的患者中，利多卡因也可能有助于取得良好疗效。
