Amann F W, Candinas R
Kardiologische Abteilung, Universitätsspital Zürich.
Ther Umsch. 1993 Jun;50(6):419-24.
Numerous factors contribute to the genesis of arrhythmias and sudden cardiac death in patients with congestive heart failure. Fibrosis of myocardium, ischemia, dilatation of the ventricles and atria, electrolyte imbalance, and neurohumoral factors are examples. Various drugs used in the treatment of congestive heart failure can also precipitate serious arrhythmias. The role of antiarrhythmics, including amiodarone, is still controversial. Judicious antiarrhythmic therapy involves weighing potential benefits of such therapy against risks, such as worsening heart failure or proarrhythmia. In patients with heart failure antiarrhythmic drugs should only be used for symptomatic arrhythmias. Low-dose beta-blockade offers a promising measure for the prevention of sudden cardiac death even in patients with symptomatic congestive heart failure.
多种因素导致充血性心力衰竭患者发生心律失常和心源性猝死。心肌纤维化、缺血、心室和心房扩张、电解质失衡以及神经体液因素等都是例子。用于治疗充血性心力衰竭的各种药物也可能引发严重心律失常。包括胺碘酮在内的抗心律失常药物的作用仍存在争议。明智的抗心律失常治疗需要权衡这种治疗的潜在益处与风险，如心力衰竭恶化或促心律失常。在心力衰竭患者中，抗心律失常药物仅应用于有症状的心律失常。即使是有症状的充血性心力衰竭患者，低剂量β受体阻滞剂也为预防心源性猝死提供了一种有前景的措施。
