Ozdil E, Carlson T A, Massumi A
Department of Adult Cardiology, Texas Heart Institute, Houston 77030, USA.
Tex Heart Inst J. 1995;22(1):40-3.
Amiodarone appears to be an effective antiarrhythmic agent for reducing mortality in the postmyocardial infarction patient with ventricular ectopic activity. Such activity has long been recognized to have an adverse effect on prognosis after acute myocardial infarction. When a strong correlation between ectopic activity and left ventricular dysfunction was demonstrated, ventricular ectopic activity was thought to be a consequence of underlying myocardial damage. However, ventricular ectopic activity is now considered to be an independent risk factor for mortality after myocardial infarction. Because of the basic premise that a positive correlation existed between arrhythmia suppression and improved survival, it had been common practice to use antiarrhythmic agents to treat asymptomatic ventricular ectopic activity in the postinfarction patient. After the results of the Cardiac Arrhythmia Suppression Trial (CAST) were released, this practice was largely abandoned. In the post-CAST era, however, amiodarone has appeared to improve survival in patients who have sustained myocardial infarctions. In this report, we briefly review the pharmacology of amiodarone and discuss the results of relevant clinical trials. Large, multicenter trials currently under way may clarify some of the unanswered questions surrounding the use of this promising antiarrhythmic agent in postmyocardial infarction patients.
胺碘酮似乎是一种有效的抗心律失常药物，可降低心肌梗死后伴有室性异位活动患者的死亡率。长期以来，人们一直认为这种活动对急性心肌梗死后的预后有不良影响。当异位活动与左心室功能障碍之间表现出强烈相关性时，室性异位活动被认为是潜在心肌损伤的结果。然而，现在室性异位活动被视为心肌梗死后死亡的独立危险因素。由于心律失常抑制与生存改善之间存在正相关这一基本前提，使用抗心律失常药物治疗心肌梗死后患者的无症状室性异位活动一直是常见做法。在心律失常抑制试验（CAST）结果公布后，这种做法在很大程度上被摒弃。然而，在CAST试验后的时代，胺碘酮似乎可提高心肌梗死患者的生存率。在本报告中，我们简要回顾胺碘酮的药理学，并讨论相关临床试验的结果。目前正在进行的大型多中心试验可能会阐明围绕这种有前景的抗心律失常药物在心肌梗死后患者中使用的一些未解决问题。
