Storstein L
Division of Clinical Pharmacology and Toxicology, Ullevaal Hospital, University of Oslo, Norway.
Eur Heart J. 1989 Aug;10 Suppl C:9-12. doi: 10.1093/eurheartj/10.suppl_c.9.
Electrophysiological defects are common and diverse features of heart failure. Cardiac arrhythmias may be precipitated by mechanical factors, catecholamine release, ischaemia drug therapy or drug-induced hypokalaemia. There is a high prevalence of ventricular and supraventricular arrhythmias, and chronic atrial fibrillation is also common. Ventricular arrhythmias are characterized by multiform, bigeminal and paired beats. There is also a high incidence of non-sustained ventricular tachycardia. These abnormalities are particularly prevalent amongst patients in New York Heart Association (NYHA) functional class IV. Although the presence of complex ventricular arrhythmias and non-sustained ventricular tachycardia are regarded as prognostic markers, their role in the initiation of sudden death has yet to be proven. The results of a recent placebo-controlled clinical trial have indicated that combined therapy with isosorbide dinitrate and hydralazine can reduce mortality due to sudden death or pump failure, and is superior in this respect to prazosin. In another key study, enalapril was superior to placebo at lowering mortality caused by pump failure, but did not reduce the incidence of sudden death. These findings point to new directions of investigation which might clarify the importance of arrhythmias in heart failure, and reveal improved ways of controlling cardiac rhythm and improving prognosis.
电生理缺陷是心力衰竭常见且多样的特征。心律失常可能由机械因素、儿茶酚胺释放、缺血、药物治疗或药物引起的低钾血症诱发。室性和室上性心律失常的患病率很高，慢性房颤也很常见。室性心律失常的特征为多形性、二联律和成对搏动。非持续性室性心动过速的发生率也很高。这些异常在纽约心脏协会（NYHA）心功能IV级患者中尤为普遍。尽管复杂室性心律失常和非持续性室性心动过速的存在被视为预后标志物，但其在猝死发生中的作用尚未得到证实。最近一项安慰剂对照临床试验的结果表明，硝酸异山梨酯和肼屈嗪联合治疗可降低猝死或泵衰竭导致的死亡率，在这方面优于哌唑嗪。在另一项关键研究中，依那普利在降低泵衰竭导致的死亡率方面优于安慰剂，但并未降低猝死的发生率。这些发现为研究指明了新方向，可能会阐明心律失常在心力衰竭中的重要性，并揭示控制心律和改善预后的更好方法。
