Lüderitz B, Manz M
Medizinische Universitätsklinik, Innere Medizin--Kardiologie, Bonn.
Z Kardiol. 1988;77 Suppl 5:143-9.
The hemodynamic consequences of ventricular tachyarrhythmias are influenced by age, underlying cardiac disease, left ventricular ejection fraction, and possibly by atrial natriuretic peptide. Severity and frequency of the rhythm disorder play, of course, a major role, e.g., monomorphic or polymorphic ventricular premature complexes (VPC), rare or frequent VPC, ventricular tachycardia, ventricular flutter or fibrillation, torsade de pointes, and tachycardia, etc. The therapeutic approach with antiarrhythmic drugs or cardiac pacemakers in cases of conduction disturbances have an additional impact on cardiac performance. Compared to ventricular pacing, a significant higher cardiac output was observed during AV sequential (so called "physiological") pacing evaluated by radionuclide ventriculography. Especially in patients with a reduced left ventricular ejection fraction, the negative inotropic effects of antiarrhythmic drugs are of major importance. A decrease of cardiac output may occur under beta-blocking agents, propafenone, flecainide and particularly disopyramide. On the other hand, amiodarone does not impair cardiac output significantly during acute high dose loading and longterm therapy. In general, negative inotropic effects of antiarrhythmic substances are overestimated; they may even be neglected as long as the antiarrhythmic agent leads to effective suppression of the symptomatic ventricular tachyarrhythmia.
室性快速心律失常的血流动力学后果受年龄、潜在心脏病、左心室射血分数影响，还可能受心房利钠肽影响。当然，心律失常的严重程度和发作频率起着主要作用，例如单形性或多形性室性早搏复合体（VPC）、偶发或频发VPC、室性心动过速、室性扑动或颤动、尖端扭转型室速以及心动过速等。在传导障碍情况下，使用抗心律失常药物或心脏起搏器的治疗方法会对心脏功能产生额外影响。与心室起搏相比，通过放射性核素心室造影评估发现，房室顺序（所谓“生理性”）起搏期间的心输出量显著更高。特别是在左心室射血分数降低的患者中，抗心律失常药物的负性肌力作用至关重要。在使用β受体阻滞剂、普罗帕酮、氟卡尼尤其是丙吡胺时，心输出量可能会降低。另一方面，在急性高剂量负荷和长期治疗期间，胺碘酮对心输出量的影响不显著。一般来说，抗心律失常药物的负性肌力作用被高估了；只要抗心律失常药物能有效抑制有症状的室性快速心律失常，甚至可以忽略不计。
