Lévy S
Division of Cardiology, Hôpital Nord, Marseille, France.
Cardiovasc Drugs Ther. 1994 Oct;8(5):769-71. doi: 10.1007/BF00877125.
The endpoint of pharmacologic therapy in patients with recurrent paroxysmal atrial fibrillation or in patients with chronic atrial fibrillation successfully cardioverted is to prevent recurrences. Recent studies have cautioned against the use of sodium channel blockers (class I agents) in terms of safety. A number of patients with atrial fibrillation have coronary artery disease and the use of class I agents may be of concern, as suggested by the CAST trial. Recently a concern was also raised, regarding the safety of quinidine following cardioversion of atrial fibrillation. In patients with congestive heart failure on antiarrhythmic therapy, the SPAF trial has shown an increase in cardiac mortality and arrhythmic deaths. In this review a case is made in favor of the use of low-dose amiodarone as a first-line agent in patients with atrial fibrillation. Amiodarone is a potent antiarrhythmic agent with little if any negative inotropic effect and, therefore, is the agent of choice in patients with heart failure. In patients with coronary artery disease, the antianginal properties may be useful, and recent studies have shown a decrease in sudden death in the amiodarone group. Therefore, a number of advantages do exist in favor of the use of amiodarone as a first-line drug, at least in selected indications.
对于复发性阵发性心房颤动患者或成功转复的慢性心房颤动患者，药物治疗的终点是预防复发。近期研究就安全性问题对使用钠通道阻滞剂（I类药物）提出了警示。心房颤动患者中有不少患有冠状动脉疾病，正如CAST试验所提示的，使用I类药物可能令人担忧。最近，关于心房颤动转复后奎尼丁的安全性也引发了关注。在接受抗心律失常治疗的充血性心力衰竭患者中，SPAF试验显示心脏死亡率和心律失常性死亡有所增加。在本综述中，有理由支持将低剂量胺碘酮作为心房颤动患者的一线用药。胺碘酮是一种强效抗心律失常药物，几乎没有负性肌力作用，因此是心力衰竭患者的首选药物。对于冠状动脉疾病患者，其抗心绞痛特性可能有益，近期研究表明胺碘酮组的猝死率有所降低。因此，至少在特定适应症中，使用胺碘酮作为一线药物确实存在诸多优势。
