Olsson G, Rehnqvist N
Department of Medicine, Karolinska Institute, Danderyd Hospital, Sweden.
Am J Cardiol. 1989 Dec 5;64(20):57J-60J. doi: 10.1016/0002-9149(89)91201-0.
In the patient with coronary artery disease, complex ventricular arrhythmias and frequent ventricular arrhythmias appear to be independent risk factors for subsequent death, particularly in patients who have had myocardial infarction. In patients with symptomatic arrhythmias, treatment must be instituted and tested during rigorous supervision of the patient. Using both the noninvasive Holter monitoring/exercise test procedure and invasive electrophysiologic testing, a beneficial antiarrhythmic response after institution of antiarrhythmic agents indicates improved prognosis. However, a negative treatment response during programmed stimulation does not necessarily indicate bad prognosis. This is particularly true for testing during amiodarone treatment. For unselected patients, routine antiarrhythmic treatment cannot currently be recommended. Continuing studies will show whether screening for electrical instability of the myocardium, and institution of antiarrhythmic therapy thereafter, will improve overall survival. If patients tolerate beta-blocking treatment, this should probably be instituted because reductions in mortality have been found, particularly in high-risk patients.
在冠心病患者中，复杂室性心律失常和频发室性心律失常似乎是随后死亡的独立危险因素，尤其是在心肌梗死患者中。对于有症状性心律失常的患者，必须在对患者进行严格监测的情况下开始并测试治疗。使用无创动态心电图监测/运动试验程序和有创电生理检查，抗心律失常药物治疗后有益的抗心律失常反应表明预后改善。然而，程序刺激期间的阴性治疗反应不一定表明预后不良。这在胺碘酮治疗期间的检查中尤其如此。对于未选择的患者，目前不建议进行常规抗心律失常治疗。持续的研究将表明，筛查心肌电不稳定性并随后进行抗心律失常治疗是否会改善总体生存率。如果患者能耐受β受体阻滞剂治疗，可能应该进行，因为已发现死亡率会降低，尤其是在高危患者中。
