Velebit V, Podrid P, Lown B, Cohen B H, Graboys T B
Circulation. 1982 May;65(5):886-94. doi: 10.1161/01.cir.65.5.886.
Antiarrhythmic drugs may aggravate or even induce ventricular arrhythmias. This type of adverse reaction is becoming more prevalent as the use of antiarrhythmic agents becomes more widespread. In a retrospective analysis of antiarrhythmic drug action, a worsening of arrhythmia was observed in 80 of 722 (11.1%) antiarrhythmic drug tests in 53 of 155 patients being treated for ventricular tachyarrhythmias. Aggravation of arrhythmias was defined by occurrence of a fourfold increase in the frequency of ventricular premature complexes, a 10-fold increase in repetitive forms, or the first emergence of sustained ventricular tachycardia coincident with time course of action of the particular drug under study. Such aggravation was noted with each of nine drugs tested: quinidine, procainamide, disopyramide, propranolol, metoprolol, aprindine, mexiletine, tocainide and pindolol. The frequency of this complication for a specific drug ranged from 5.9-15.8%. Blood drug concentrations were consistently in the therapeutic range. A study of the variability of ventricular arrhythmia during 48-hour Holter monitoring and exercise stress testing in no instance showed arrhythmia enhancement commensurate with that defining aggravation. Our data suggest that this potentially serious complication is not readily predictable and requires a systematic approach to antiarrhythmic drug testing before a patient is prescribed a long-range maintenance program.
抗心律失常药物可能会加重甚至诱发室性心律失常。随着抗心律失常药物的使用越来越广泛，这种不良反应也越来越普遍。在一项关于抗心律失常药物作用的回顾性分析中，155例接受室性快速心律失常治疗的患者中，有53例进行了722次抗心律失常药物试验，其中80次（11.1%）出现了心律失常恶化。心律失常加重的定义为室性早搏频率增加四倍、重复形式增加十倍，或与所研究的特定药物作用时间过程一致的持续性室性心动过速首次出现。在所测试的九种药物中均观察到了这种加重情况：奎尼丁、普鲁卡因胺、丙吡胺、普萘洛尔、美托洛尔、阿普林定、美西律、妥卡尼和吲哚洛尔。特定药物这种并发症的发生率在5.9%至15.8%之间。血药浓度始终在治疗范围内。在48小时动态心电图监测和运动应激试验期间对室性心律失常变异性的研究中，没有一例显示心律失常增强程度与定义加重情况相符。我们的数据表明，这种潜在的严重并发症不易预测，在为患者制定长期维持治疗方案之前，需要采用系统的方法进行抗心律失常药物试验。
