Kerin N Z, Blevins R D, Benaderet D, Faitel K, Jarandilla R, Garfinkel C, Klein S, Rubenfire M
Am J Cardiol. 1986 Jan 1;57(1):128-30. doi: 10.1016/0002-9149(86)90965-3.
The relation of serum reverse T3 (rT3) to amiodarone efficacy and toxicity was studied in 31 patients with frequent and complex ventricular arrhythmias. Baseline studies included 48-hour Holter recordings and rT3 levels (normal 33 ng/dl or less). Amiodarone therapy was initiated with a 5 mg/kg infusion followed by 600 to 800 mg/day for 7 to 10 days, then 200 to 400 mg/day. Holters and rT3 levels were repeated every 1 to 3 months and amiodarone was titrated to achieve at least a 70% reduction in total ventricular premature complexes, at least a 90% reduction in couplets and abolition of ventricular tachycardia. The baseline rT3 level was 18 +/- 7 ng/dl (range 10 to 30) and patients were followed 12 +/- 9 months. Arrhythmia control was achieved in 25 patients (81%), including 21 patients with elevated rT3 levels (36 to 105 ng/dl) and 4 patients with normal rT3 (15 to 33 ng/dl). Six patients were uncontrolled with rT3 (27 to 90 ng/dl) and 14 patients had minor side effects with rT3 (27 to 123 ng/dl). Three of 4 patients in whom rT3 levels exceeded 130 ng/dl died suddenly (137 to 174 ng/dl before the event). Thus, amiodarone efficacy and minor toxicity occurs at rT3 levels less than 105 ng/dl and sudden death may be associated with levels greater than 130 ng/dl.
对31例频发复杂性室性心律失常患者研究了血清反三碘甲状腺原氨酸（rT3）与胺碘酮疗效及毒性的关系。基线研究包括48小时动态心电图记录及rT3水平（正常为33 ng/dl或更低）。胺碘酮治疗起始为5 mg/kg静脉输注，随后7至10天为600至800 mg/天，然后200至400 mg/天。每1至3个月重复动态心电图及rT3水平测定，并调整胺碘酮剂量，以使室性早搏总数至少减少70%，成对室性早搏至少减少90%，并消除室性心动过速。基线rT3水平为18±7 ng/dl（范围10至30），患者随访12±9个月。25例患者（81%）心律失常得到控制，其中21例rT3水平升高（36至105 ng/dl），4例rT3正常（15至33 ng/dl）。6例患者心律失常未得到控制（rT3为27至90 ng/dl），14例患者有轻微副作用（rT3为27至123 ng/dl）。4例rT3水平超过130 ng/dl的患者中有3例突然死亡（事件发生前为137至174 ng/dl）。因此，胺碘酮疗效及轻微毒性发生在rT3水平低于105 ng/dl时，而猝死可能与rT3水平高于130 ng/dl有关。
