Warrington S J, Hamer J
Postgrad Med J. 1980 Apr;56(654):229-33. doi: 10.1136/pgmj.56.654.229.
Five patients with apparent adverse cardiovascular effects of disopyramide are reveiwed. Attention is drawn to the following problems. (1) A vagolytic effect may produce a sinus tachycardia with wide QRS complexes due to aberrant conduction or intraventricular block superficially resembling a ventricular tachycardia, or may allow increased transmission of an atrial tachycardia or atrial flutter to the ventricles by improving atrio-ventricular conduction. (2) Although the vagolytic effect is helpful in increasing sinus rate in patients with sinus node disease, disopyramide may lead to bradycardia and asytolic cardiac arrest, and should not be used without a demand pacemaker. (3) Dangerous ventricular arrhythmias may be provoked in susceptible subjects, as with quinidine. (4) Rapid intravenous injection may produce transient toxic effects before the drug is distributed. The rate of injection as a loading dose for prophylaxis should be slower (2 mg/kg in 15 min) than for the urgent conversion of a resistent tachycardia (2 mg/kg in 5 min). Although disopyramide seems less toxic than quinidine, caution is advised, as over-enthusiastic application of disopyramide, particularly with rapid intravenous injection, might tend to bring a useful new agent into disrepute.
对5例出现丙吡胺明显心血管不良反应的患者进行了回顾。需关注以下问题：(1) 抗迷走神经作用可能导致窦性心动过速，伴有因异常传导或室内传导阻滞引起的宽大QRS波群，表面上类似于室性心动过速，或者可能通过改善房室传导使房性心动过速或心房扑动更多地下传至心室。(2) 虽然抗迷走神经作用有助于提高窦房结疾病患者的窦性心率，但丙吡胺可能导致心动过缓和心搏停止，在没有按需起搏器的情况下不应使用。(3) 与奎尼丁一样，易感人群可能会诱发危险的室性心律失常。(4) 快速静脉注射可能在药物分布前产生短暂的毒性作用。作为预防用药的负荷剂量时，注射速度（15分钟内2mg/kg）应比用于紧急转复顽固性心动过速时（5分钟内2mg/kg）慢。虽然丙吡胺的毒性似乎比奎尼丁小，但建议谨慎使用，因为过度积极地应用丙吡胺，尤其是快速静脉注射，可能会使一种有用的新药声名狼藉。
