Gertsch M
Schweiz Med Wochenschr. 1984 Jan 21;114(3):77-86.
Sudden death and its consequences in patients with coronary artery disease have stimulated research in this field. In the light of the literature an attempt is made to outline the present state of diagnosis and especially longterm medical treatment in ventricular arrhythmias. New morphological electrocardiographic criteria for differentiation between supraventricular and ventricular tachycardias are mentioned. It seems to be the general opinion that ventricular arrhythmias in persons with otherwise normal cardiac findings have a good prognosis and do not need drug therapy. Drug therapy of ventricular arrhythmias in patients with cardiac disease sets out to lower the incidence of sudden death and should be used only for dangerous arrhythmias (ventricular premature beats of Lown classes 3 to 5) and in patients with significant heart disease. Toxic factors and arrhythmogenic properties and other side effects of the antiarrhythmic drugs should be considered. The subdivision of these drugs into classes I to IV according to their effect on the action potential fo the isolated muscle fiber of the heart is briefly reviewed. Standard doses and important side effects of drugs generally used in the treatment of ventricular arrhythmias are given. Drug testing with invasive cardiac stimulation is complicated and expensive and is performed in a few specialized centers only. Oral drug testing with monitoring of the drug effect by ambulatory electrocardiography and measurement of blood levels usually permits the correct choice of an antiarrhythmic drug. For practical use a somewhat simplified method of oral drug testing is proposed in which rhythm strips replace the ambulatory ECG. This modification does not sufficiently allow for the spontaneous variability of ventricular ectopy, but will probably permit some guidance of the antiarrhythmic therapy. It is obvious that the practical application of the new concepts in the management of ventricular arrhythmias is difficult. Finally, the therapy of supraventricular tachyarrhythmias is briefly summarized.
冠心病患者的猝死及其后果推动了该领域的研究。根据文献，本文试图概述室性心律失常的诊断现状，尤其是长期药物治疗情况。文中提到了用于鉴别室上性和室性心动过速的新的形态学心电图标准。一般认为，心脏检查结果正常者的室性心律失常预后良好，无需药物治疗。心脏病患者室性心律失常的药物治疗旨在降低猝死发生率，仅应用于危险的心律失常（Lown 3至5级室性早搏）以及患有严重心脏病的患者。应考虑抗心律失常药物的毒性因素、致心律失常特性及其他副作用。简要回顾了根据这些药物对心脏孤立肌纤维动作电位的影响将其分为I至IV类的情况。给出了一般用于治疗室性心律失常的药物的标准剂量和重要副作用。侵入性心脏刺激进行药物测试复杂且昂贵，仅在少数专业中心开展。通过动态心电图监测药物效果并测量血药浓度进行口服药物测试通常能正确选择抗心律失常药物。为实际应用，提出了一种简化的口服药物测试方法，即用节律条图取代动态心电图。这种改进虽不能充分考虑室性异位搏动的自发变异性，但可能会为抗心律失常治疗提供一些指导。显然，将这些新概念实际应用于室性心律失常的管理存在困难。最后，简要总结了室上性快速心律失常的治疗方法。
