JCS Shock Registry Scientific Committee, Tokyo, Japan.
Department of Emergency and Intensive Care Center, Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan.
Heart Vessels. 2021 Sep;36(9):1430-1437. doi: 10.1007/s00380-021-01821-2. Epub 2021 Mar 15.
Although antiarrhythmic drugs have long been used for the suppression of various types of arrhythmias, their prior use before the onset of ventricular arrhythmia with hemodynamic collapse and the effect on prognosis is not well known. Data from 1004 consecutive patients with cardiovascular shock in the Japanese Circulation Society's Shock Registry were analyzed. Eighty-four cases of ventricular arrhythmia-induced shock and ROSC (return of spontaneous circulation) were divided into the prior amiodarone or β-blockers use group (Aβ group, n = 27) and the non-amiodarone and non-β-blockers use group (non-Aβ group; n = 57) based on treatment before the onset of those arrhythmias. Clinical outcomes related to hemodynamic collapse such as OHCA (out-of-hospital cardiovascular arrest) was less in the Aβ group [Aβ group, 11/26 (42%) vs. non-Aβ group, 41/56 (73%); p = 0.007]. Similarly, syncope was less common in the Aβ group than in the non-Aβ group [Aβ group 4/27 (15%) vs. non-Aβ group 27/57 (47%); p = 0.004]. Furthermore, prior amiodarone or β-blockers use before the onset of ventricular arrhythmias was strongly associated with both survival at discharge (odds ratio 3.19; 95% confidence interval 1.06-9.67; p = 0.040) and neurological outcomes at discharge (odds ratio 3.96; 95% confidence interval 1.32-11.85; p = 0.014) based on multivariate logistic regression analysis. Prior amiodarone or β-blockers use before the onset of malignant ventricular arrhythmia and maintaining appropriate blood concentrations in advance is associated with a good survival rate and better neurological outcomes after recovery from ventricular arrhythmia with hemodynamic collapse.
虽然抗心律失常药物长期以来一直被用于抑制各种类型的心律失常，但它们在出现伴有血液动力学崩溃的室性心律失常之前的使用情况及其对预后的影响尚不清楚。对日本循环学会休克登记处的 1004 例连续心血管休克患者的数据进行了分析。将 84 例由室性心律失常引起的休克和 ROSC（自主循环恢复）的病例分为胺碘酮或β受体阻滞剂治疗组（Aβ 组，n=27）和非胺碘酮和非β受体阻滞剂治疗组（非 Aβ 组；n=57），基于心律失常发作前的治疗情况。与血液动力学崩溃相关的临床结局，如 OHCA（院外心脏骤停），在 Aβ 组较少[Aβ 组，26/27（42%）vs. 非 Aβ 组，56/57（73%）；p=0.007]。同样，Aβ 组比非 Aβ 组更少见晕厥[Aβ 组 4/27（15%）vs. 非 Aβ 组 57/57（47%）；p=0.004]。此外，基于多变量逻辑回归分析，在室性心律失常发作前使用胺碘酮或β受体阻滞剂与出院时的存活率（比值比 3.19；95%置信区间 1.06-9.67；p=0.040）和出院时的神经结局（比值比 3.96；95%置信区间 1.32-11.85；p=0.014）密切相关。在恶性室性心律失常发作前预先使用胺碘酮或β受体阻滞剂并维持适当的血药浓度，与室性心律失常伴有血液动力学崩溃恢复后良好的存活率和更好的神经结局相关。
