Conti J B, Curtis A B
Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville.
Postgrad Med. 1993 Oct;94(5):121-4, 133-7. doi: 10.1080/00325481.1993.11945734.
Current information suggests that in patients with congestive heart failure (CHF) who have asymptomatic ventricular arrhythmias, coronary artery disease (dilated ischemic cardiomyopathy), and a positive signal-averaged electrocardiogram, electrophysiologic studies are useful for stratifying risk and guiding therapy. Therapy with amiodarone hydrochloride (Cordarone) appears to improve survival in patients after myocardial infarction. In CHF patients with asymptomatic ventricular arrhythmias and dilated nonischemic cardiomyopathy, electrophysiologic studies are of little value in risk stratification because of their low yield of sustained monomorphic tachycardias. There is little evidence that therapy with conventional antiarrhythmic agents improves survival. Although amiodarone can suppress ventricular ectopic beats, no trial yet conducted has detected an effect on mortality. Randomized, controlled trials with low-dose amiodarone are needed for more definitive information. Most symptomatic patients should undergo electrophysiologic testing and receive guided therapy, either with antiarrhythmic drugs or with an implantable cardioverter-defibrillator.
目前的信息表明，对于患有充血性心力衰竭（CHF）且有无症状室性心律失常、冠状动脉疾病（扩张型缺血性心肌病）以及信号平均心电图呈阳性的患者，电生理检查有助于风险分层并指导治疗。盐酸胺碘酮（可达龙）治疗似乎可提高心肌梗死后患者的生存率。在患有无症状室性心律失常和扩张型非缺血性心肌病的CHF患者中，由于持续性单形性室性心动过速的检出率低，电生理检查在风险分层方面价值不大。几乎没有证据表明传统抗心律失常药物治疗可提高生存率。虽然胺碘酮可抑制室性早搏，但尚未有试验检测到其对死亡率的影响。需要进行低剂量胺碘酮的随机对照试验以获取更确切的信息。大多数有症状的患者应接受电生理检查并接受指导治疗，可使用抗心律失常药物或植入式心脏复律除颤器。
