Wesseling H, de Graeff P A, van Gilst W H, Kingma J H, de Langen C D
Department of Pharmacology, University of Groningen, The Netherlands.
J Hum Hypertens. 1989 Jun;3 Suppl 1:89-95.
Ventricular arrhythmias (VA) are a major cause of sudden death. Life-threatening VA may be present in a variety of both acute and chronic conditions in which cardiac function is compromised: during acute myocardial infarction and subsequent reperfusion; some weeks after acute myocardial infarction, due to residual damage (scar formation with zones of heterogeneity); and as a consequence of congestive heart failure (CHF) resulting from myocardial infarction, dilated cardiomyopathy, hypertension or other causes. Symptomatic suppression of potentially life-threatening VA is unlikely to decrease mortality, since classical antiarrhythmic drugs have failed, so far, to improve life expectancy. Drugs that influence the underlying causes of CHF seem to have a better chance of reducing mortality. There is evidence that ACE inhibitors may exert beneficial effects on arrhythmogenicity by several mechanisms in these situations. Under acute ischaemic conditions both cellular damage and undue increases in circulating catecholamines and angiotensin II may be prevented. This has been demonstrated in various animal models and confirmatory clinical evidence is emerging. Two week after experimental myocardial infarction, the pig heart is less vulnerable to programmed electrical stimulation when ACE inhibitors are administered. Finally, in CHF a variety of proarrhythmic factors, such as left ventricular dysfunction, raised catecholamine levels and, in particular, decreased potassium concentrations, are influenced beneficially by ACE inhibitors.
室性心律失常（VA）是猝死的主要原因。危及生命的VA可能存在于各种急性和慢性心脏功能受损的情况中：急性心肌梗死期间及随后的再灌注过程中；急性心肌梗死后数周，由于残留损伤（形成具有异质性区域的瘢痕）；以及心肌梗死、扩张型心肌病、高血压或其他原因导致的充血性心力衰竭（CHF）。对潜在危及生命的VA进行症状性抑制不太可能降低死亡率，因为迄今为止，经典抗心律失常药物未能提高预期寿命。影响CHF潜在病因的药物似乎更有可能降低死亡率。有证据表明，在这些情况下，血管紧张素转换酶（ACE）抑制剂可能通过多种机制对心律失常产生有益影响。在急性缺血情况下，细胞损伤以及循环儿茶酚胺和血管紧张素II的过度增加都可能被预防。这已在各种动物模型中得到证实，并且越来越多的确证性临床证据也正在出现。实验性心肌梗死后两周，给予ACE抑制剂时猪心脏对程序性电刺激的易感性降低。最后，在CHF中，ACE抑制剂可对多种促心律失常因素产生有益影响，如左心室功能障碍、儿茶酚胺水平升高，尤其是钾浓度降低。
