Bigger J T, Sahar D I
Am J Cardiol. 1987 Apr 30;59(11):2E-9E. doi: 10.1016/0002-9149(87)90195-0.
The problem of drug-induced or drug-aggravated cardiac arrhythmias has been recognized for many years. Digitalis glycosides and class I, II, III, or IV antiarrhythmic drugs can cause severe sinus node dysfunction or atrioventricular block. Digitalis can cause a variety of supraventricular arrhythmias; atrial tachycardia with block and nonparoxysmal atrioventricular junctional tachycardia are the most characteristic. Recognition that class IA and class III antiarrhythmic drugs can aggravate arrhythmias or cause new arrhythmias in patients being treated for potentially malignant or malignant ventricular arrhythmias has intensified the interest in proarrhythmia in recent years. Several characteristic types of proarrhythmic response have been described. Torsades de pointes (multiform) ventricular tachycardia (VT) accompanied by prolongation of the QT interval can be caused by class IA and class III antiarrhythmic drugs as well as other drugs that bind to the membrane sodium channels of ventricular cells, for example, tricyclic antidepressants. Uniform VT in patients with malignant ventricular arrhythmias and poor left ventricular function is a characteristic proarrhythmic response to class IC antiarrhythmic drugs. Bidirectional VT or accelerated idioventricular rhythm are characteristic of digitalis toxicity. More difficult to establish as proarrhythmic responses are increased frequency of ventricular premature depolarizations and increased ease of inducing VT with programmed ventricular stimulation.
药物诱发或加重的心律失常问题已被认识多年。洋地黄苷类以及I类、II类、III类或IV类抗心律失常药物可导致严重的窦房结功能障碍或房室传导阻滞。洋地黄可引起多种室上性心律失常；伴有阻滞的房性心动过速和非阵发性房室交界性心动过速最为典型。近年来，认识到IA类和III类抗心律失常药物可使正在接受潜在恶性或恶性室性心律失常治疗的患者的心律失常加重或引发新的心律失常，这使得人们对致心律失常作用的关注度提高。已经描述了几种特征性的致心律失常反应类型。IA类和III类抗心律失常药物以及其他与心室细胞的膜钠通道结合的药物（例如三环类抗抑郁药）可导致伴有QT间期延长的尖端扭转型（多形性）室性心动过速（VT）。恶性室性心律失常且左心室功能较差的患者出现的单形性VT是对IC类抗心律失常药物的特征性致心律失常反应。双向VT或加速性室性自主心律是洋地黄毒性的特征。更难以确定为致心律失常反应的是室性早搏去极化频率增加以及通过程控心室刺激诱发VT的易感性增加。
