Yusoff K, Tai Y T, Campbell R W
Freeman Hospital, Newcastle, UK.
Z Kardiol. 1988;77 Suppl 5:137-42.
Complex adjustments in contractility, resistance, stroke volume and atrio-ventricular contraction relationships underlie the optimization of cardiac output during variations in sinus rate. In patients with intra AV nodal re-entry tachycardia and accessory pathway tachycardias, rate and loss of appropriately timed atrial transport reduce cardiac efficiency, but this is serious only when heart rates are very high. True atrial tachycardia, atrial fibrillation, and atrial flutter are often associated with cardiovascular disease. In atrial fibrillation and flutter, loss of atrial transport may be less important than the hemodynamic consequences of irregularity of ventricular systole. Antiarrhythmic management may ameliorate the consequences of the arrhythmia by reducing heart rate, restoring sinus rhythm or more controversially by regularizing ventricular contraction. Digoxin and antiarrhythmic surgery have little negative inotropic potential but most other antiarrhythmic drugs and ablation procedures depress myocardial function. Antitachycardia pacemakers may produce acute adverse hemodynamic effects depending upon the type of pulse trains delivered to terminate the tachycardia.
在窦性心律变化期间，心脏收缩力、阻力、每搏输出量和房室收缩关系的复杂调整是心输出量优化的基础。在房室结内折返性心动过速和旁路性心动过速患者中，心率以及适时的心房运输功能丧失会降低心脏效率，但仅在心率非常高时才会产生严重影响。真正的房性心动过速、心房颤动和心房扑动常与心血管疾病相关。在心房颤动和心房扑动中，心房运输功能丧失可能不如心室收缩不规则所带来的血流动力学后果重要。抗心律失常治疗可通过降低心率、恢复窦性心律，或者更具争议性地通过使心室收缩规律化来改善心律失常的后果。地高辛和抗心律失常手术几乎没有负性肌力作用，但大多数其他抗心律失常药物和消融手术会抑制心肌功能。抗心动过速起搏器可能会产生急性不良血流动力学效应，这取决于用于终止心动过速的脉冲序列类型。
