Echt D S, Shapiro M, Trusso J, Mason J W, Winkle R A
Am Heart J. 1985 Jan;109(1):28-33. doi: 10.1016/0002-8703(85)90411-9.
Fifty patients with drug-refractory (failed 7 +/- 2 other drug trials) sustained ventricular tachycardia or fibrillation were treated with oral lorcainide. Twenty-three patients underwent programmed stimulation both before and after oral lorcainide, and all 23 remained inducible, although ventricular tachycardia cycle length was prolonged and mean arterial pressure was higher. Lorcainide was discontinued in 23 patients prior to hospital discharge because of death in four patients, side effects in five patients, spontaneous clinical arrhythmia recurrence in six patients, and ventricular tachyarrhythmias induced at electrophysiologic study in eight patients. Twenty-seven patients were discharged on an average dose of 169 +/- 56 mg twice a day, including 15 in whom ventricular tachycardia remained inducible. During long-term follow-up the drug was discontinued in 15 patients; three because of side effects, three because of clinical nonfatal arrhythmia recurrence, two who selected other alternative therapy, and seven patients who died suddenly due to ventricular tachyarrhythmias. Twelve patients remain on long-term lorcainide. The actuarial 1-year chance of being arrhythmia free was 38.9%, and 1-year cardiovascular and arrhythmia survival rates were 56.8% and 60.4%, respectively. Based on our data we conclude that: In this extremely drug-resistant patient population the clinical efficacy of lorcainide is low; lorcainide should not be used empirically in such highly drug-resistant patients; persistent ventricular tachyarrhythmia inducibility at electrophysiologic study implies a poor prognosis in patients treated with oral lorcainide; the incidence of becoming noninducible during oral lorcainide therapy in highly drug-resistant patients appears low; and for patients in whom the drug seems partially beneficial it could be used in conjunction with a backup automatic implantable cardioverter/defibrillator.
50例药物难治性（7±2次其他药物试验失败）持续性室性心动过速或颤动患者接受了口服劳卡尼治疗。23例患者在口服劳卡尼前后均接受了程序刺激，尽管室性心动过速周期长度延长且平均动脉压升高，但所有23例患者仍可诱发心律失常。23例患者在出院前停用了劳卡尼，原因是4例患者死亡，5例患者出现副作用，6例患者临床心律失常自发复发，8例患者在电生理研究中诱发室性快速心律失常。27例患者出院时平均剂量为每日两次169±56mg，其中15例患者室性心动过速仍可诱发。在长期随访中，15例患者停用了该药物；3例是因为副作用，3例是因为临床非致命性心律失常复发，2例选择了其他替代治疗，7例患者因室性快速心律失常突然死亡。12例患者仍在长期服用劳卡尼。无心律失常的1年精算概率为38.9%，1年心血管和心律失常生存率分别为56.8%和60.4%。根据我们的数据，我们得出以下结论：在这个极具耐药性的患者群体中，劳卡尼的临床疗效较低；在这种高度耐药的患者中不应凭经验使用劳卡尼；电生理研究中持续性室性快速心律失常可诱发提示口服劳卡尼治疗的患者预后不良；在高度耐药患者口服劳卡尼治疗期间转为不可诱发的发生率似乎较低；对于药物似乎有部分益处的患者，可将其与备用自动植入式心脏复律除颤器联合使用。
