Hermida J S, Coumel P, Leclercq J F, Cauchemez B, Maison-Blanche P, Leenhardt A, Slama R
Arch Mal Coeur Vaiss. 1987 Mar;80(3):290-300.
Beta-blockers were used to treat 20 patients (mean age 55 +/- 12 years) presenting with severe ventricular arrhythmia on chronic heart failure (NYHA stages II to IV; mean ejection fraction 29.7 +/- 7.8%) due to coronary disease (18 cases) or to cardiomyopathy (2 cases). Ventricular tachycardia sustained (7.6 +/- 6.3 attacks/patient) in 19 patients, unsustained in 18, monomorphous in 8 and polymorphous in 12, had been present for 12.4 +/- 18 months. In all but one hitherto untreated patient, the condition had failed to respond to amiodarone combined with a type Ia (19 patients) and type Ic (16 patients) antiarrhythmic drug. Short-term results were: 17 successes, 2 failures and 1 death due to cardiogenic shock. Fifteen patients were followed up for 14 +/- 6.7 months. Thirteen of them benefited from smaller doses of a formerly ineffective treatment; there was one failure, and one patient in whom the attacks of tachycardia, but not the numerous and polymorphous extrasystoles, were controlled by the beta-blockers suddenly died at night. The actuarial mortality rate was 11.4% as against an expected figure of 30% in such a high risk group. Although no significant changes in ejection fraction were observed, heart failure became worse in 8 patients, but it was compensated by diuretics and/or vasodilators. The effects of beta-blockers in resistant ventricular arrhythmia on heart failure suggest that an adrenergic factor is involved in the mechanism of arrhythmia. Provided treatment is progressive and its haemodynamic consequences carefully monitored, beta-blockade is well tolerated. Its effectiveness on severe arrhythmia and on mortality rate seems to confirm that it prevents sudden death by an anti-arrhythmic mechanism.
β受体阻滞剂用于治疗20例（平均年龄55±12岁）因冠心病（18例）或心肌病（2例）导致慢性心力衰竭（纽约心脏协会II至IV级；平均射血分数29.7±7.8%）并伴有严重室性心律失常的患者。19例患者出现持续性室性心动过速（7.6±6.3次/患者发作），18例为非持续性室性心动过速，8例为单形性，12例为多形性，室性心动过速已存在12.4±18个月。除1例此前未接受治疗的患者外，其余患者的病情对胺碘酮联合Ia类（19例患者）和Ic类（16例患者）抗心律失常药物均无反应。短期结果为：17例成功，2例失败，1例因心源性休克死亡。15例患者接受了14±6.7个月的随访。其中13例患者受益于剂量较小的先前无效的治疗；有1例治疗失败，1例患者的室性心动过速发作得到控制，但大量多形性期前收缩未得到控制，该患者在夜间突然死亡。实际死亡率为11.4%，而在这样一个高危组中预期死亡率为30%。虽然未观察到射血分数有显著变化，但8例患者的心力衰竭加重，但通过利尿剂和/或血管扩张剂得到了代偿。β受体阻滞剂对难治性室性心律失常和心力衰竭的影响表明，肾上腺素能因素参与了心律失常的机制。只要治疗是逐步进行的，并仔细监测其血流动力学后果，β受体阻滞剂的耐受性良好。其对严重心律失常和死亡率的有效性似乎证实，它通过抗心律失常机制预防猝死。
