Lüderitz B
Medizinische Klinik, Universität Bonn.
Z Gesamte Inn Med. 1993 Sep;48(9):459-65.
Many new antiarrhythmic drugs effective in supraventricular tachyarrhythmia are now available. Since these compounds may lead to serious side-effects, the correct indication for the antiarrhythmic treatment has to be given regarding the ratio of risk and benefit. There is no doubt that aggravation of arrhythmia i.e. acceleration of tachycardia or even degeneration into ventricular flutter (including torsades-de-pointes tachycardia) and fibrillation may be related to the cardiac diagnosis depending on the extent of disease or left ventricular dysfunction and the presenting arrhythmia and possibly the electrophysiological effects of the drug. In general, negative inotropic effects of antiarrhythmic substances are overestimated; they may even be neglected as long as the antiarrhythmic agent leads to effective suppression of the symptomatic ventricular tachyarrhythmia. The best and most important consequence of the CAST study (Cardiac Arrhythmia Suppression Trial) showing an increase in mortality with antiarrhythmic drugs compared with placebo should be that physicians handle antiarrhythmic drugs now with more care than before. The problems with risks and side-effects in antiarrhythmic drug therapy of supraventricular arrhythmias underline the requirement for careful cardiological evaluation and monitoring in all patients receiving such drugs.
目前有许多对室上性快速心律失常有效的新型抗心律失常药物。由于这些化合物可能会导致严重的副作用，因此必须根据风险与获益的比例给出抗心律失常治疗的正确指征。毫无疑问，心律失常的加重，即心动过速加速甚至恶化为心室扑动（包括尖端扭转型心动过速）和颤动，可能与心脏诊断有关，这取决于疾病的严重程度或左心室功能障碍、所表现出的心律失常以及药物可能的电生理效应。一般来说，抗心律失常药物的负性肌力作用被高估了；只要抗心律失常药物能有效抑制有症状的室性快速心律失常，其负性肌力作用甚至可以被忽略。心律失常抑制试验（CAST）表明，与安慰剂相比，抗心律失常药物会增加死亡率，该试验带来的最好且最重要的结果应该是，医生现在使用抗心律失常药物比以前更加谨慎。室上性心律失常抗心律失常药物治疗中的风险和副作用问题突出了对所有接受此类药物治疗的患者进行仔细的心脏病学评估和监测的必要性。
