Cain M E
Washington University School of Medicine, Barnes and Wohl Hospital, St. Louis, Missouri 63110.
Angiology. 1988 Jul;39(7 Pt 2):668-83.
The purpose of this review is to discuss the role of mexiletine, tocainide, flecainide, and amiodarone in the treatment of patients with symptomatic ventricular ectopy or sustained ventricular tachycardia (VT) and fibrillation (VF). The pharmacologic properties, electrophysiologic effects, clinical efficacy, adverse reactions, and costs of these new agents are compared with those of procainamide, quinidine, and disopyramide. With the exception of more convenient dosing intervals, these new agents do not afford novel or advantageous pharmacologic properties. The incidences and severity of adverse reactions are similar to those reported with conventional antiarrhythmic drugs. Results of clinical studies demonstrate that these newer drugs are comparable to procainamide, quinidine, and disopyramide in suppressing ventricular ectopy. Accordingly, the choice of an antiarrhythmic agent for patients with symptomatic ventricular ectopy can be based on the side-effect profile. The propensity for developing certain adverse effects can be defined if patients are subgrouped by age and left ventricular function. The adverse effects of amiodarone preclude its use in patients manifesting only ventricular ectopy. Treatment of patients with sustained VT/VF is more complex. Mexiletine and tocainide are generally not effective. The efficacy of flecainide is similar to that of procainamide, quinidine, and disopyramide. The negative inotropic effects of flecainide and disopyramide preclude their use in patients with severe ventricular dysfunction. Amiodarone is the most effective of these drugs for preventing recurrences of sustained VT/VF. Its use should, however, be restricted to patients refractory or intolerant to other antiarrhythmic drugs.
本综述的目的是讨论美西律、妥卡尼、氟卡尼和胺碘酮在治疗有症状性室性早搏或持续性室性心动过速（VT）及颤动（VF）患者中的作用。将这些新药的药理特性、电生理效应、临床疗效、不良反应及成本与普鲁卡因胺、奎尼丁和丙吡胺进行比较。除了给药间隔更方便外，这些新药并没有提供新的或有利的药理特性。不良反应的发生率和严重程度与传统抗心律失常药物报道的相似。临床研究结果表明，这些新药在抑制室性早搏方面与普鲁卡因胺、奎尼丁和丙吡胺相当。因此，对于有症状性室性早搏患者，抗心律失常药物的选择可基于副作用情况。如果根据年龄和左心室功能对患者进行亚组划分，某些不良反应的发生倾向是可以确定的。胺碘酮的不良反应使其不能用于仅表现为室性早搏的患者。持续性VT/VF患者的治疗更为复杂。美西律和妥卡尼通常无效。氟卡尼的疗效与普鲁卡因胺、奎尼丁和丙吡胺相似。氟卡尼和丙吡胺的负性肌力作用使其不能用于严重心室功能不全的患者。胺碘酮是这些药物中预防持续性VT/VF复发最有效的药物。然而，其使用应限于对其他抗心律失常药物难治或不耐受的患者。
