Podrid P J
Section of Cardiology, University Hospital, Boston University School of Medicine, Massachusetts 02118.
J Cardiovasc Electrophysiol. 1993 Jun;4(3):311-9. doi: 10.1111/j.1540-8167.1993.tb01233.x.
Aggravation of arrhythmia, defined as worsening of a preexisting arrhythmia or the occurrence of a new arrhythmia, is a common complication of antiarrhythmic drug therapy. Although it is largely an unpredictable event, patients at greatest risk are those with a history of congestive heart failure due to systolic dysfunction who present with a sustained ventricular tachyarrhythmia. As a rule, aggravation of arrhythmia is an early event, occurring within the first few days of initiating therapy. However, in the Cardiac Arrhythmia Suppression Trial (CAST), the increased sudden death mortality due to drug therapy, which was a result of arrhythmia aggravation, occurred throughout the entire duration of the trial, suggesting that arrhythmia aggravation can also be a late complication of therapy. Also disturbing was the fact that patients in CAST were low risk and did not have congestive heart failure or a serious ventricular tachyarrhythmia. This suggests that another important risk factor is myocardial ischemia and its potentially dangerous interaction with antiarrhythmic drugs. In patients with heart disease, especially those with coronary artery disease, antiarrhythmic drugs must therefore be used cautiously. Close and continuous follow-up is mandatory.
心律失常加重被定义为既往存在的心律失常恶化或出现新的心律失常，是抗心律失常药物治疗的常见并发症。尽管这在很大程度上是一个不可预测的事件，但风险最高的患者是那些因收缩功能障碍导致充血性心力衰竭且出现持续性室性快速心律失常的患者。通常，心律失常加重是一个早期事件，发生在开始治疗的头几天内。然而，在心律失常抑制试验（CAST）中，由于药物治疗导致的猝死死亡率增加，这是心律失常加重的结果，在整个试验期间都有发生，这表明心律失常加重也可能是治疗的晚期并发症。同样令人不安的是，CAST中的患者风险较低，没有充血性心力衰竭或严重的室性快速心律失常。这表明另一个重要的风险因素是心肌缺血及其与抗心律失常药物的潜在危险相互作用。因此，在患有心脏病的患者中，尤其是那些患有冠状动脉疾病的患者，必须谨慎使用抗心律失常药物。密切且持续的随访是必不可少的。
