Olson P J, Woelfel A, Simpson R J, Foster J R
Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill.
Am J Cardiol. 1993 Apr 1;71(10):823-6. doi: 10.1016/0002-9149(93)90831-v.
One hundred twenty-two patients treated chronically with amiodarone for sustained ventricular tachycardia or ventricular fibrillation after failing conventional antiarrhythmic therapy were analyzed to determine which factors were predictive of sudden cardiac death during follow-up. The mean left ventricular ejection fraction in the study group was 0.32, and 87% of the patients had coronary artery disease with a prior myocardial infarction. During a median follow-up of 19.5 months, 30 patients died suddenly. The only variable that was predictive of sudden death was left ventricular ejection fraction. Twenty-nine of the 84 patients with ejection fractions < 0.40 died suddenly, compared with 1 of 35 patients with ejection fractions > or = 0.40. The actuarial probability of sudden death at 5 years was 49% when the ejection fraction was < 0.40, and 5% when the ejection fraction was > or = 0.40 (p = 0.0004). These results indicate that patients treated with amiodarone for sustained ventricular tachycardia or ventricular fibrillation whose ejection fractions are > or = 0.40 are at low risk for sudden death. Patients with ejection fractions < 0.40 remain at high risk for sudden death, and should be considered for additional or alternative therapy.
对122例在常规抗心律失常治疗失败后长期使用胺碘酮治疗持续性室性心动过速或室颤的患者进行分析，以确定哪些因素可预测随访期间的心源性猝死。研究组的平均左心室射血分数为0.32，87%的患者患有冠状动脉疾病且既往有心肌梗死病史。在中位随访19.5个月期间，30例患者突然死亡。唯一可预测猝死的变量是左心室射血分数。射血分数<0.40的84例患者中有29例突然死亡，而射血分数≥0.40的35例患者中有1例突然死亡。射血分数<0.40时，5年猝死的精算概率为49%，而射血分数≥0.40时为5%（p = 0.0004）。这些结果表明，射血分数≥0.40的持续性室性心动过速或室颤患者接受胺碘酮治疗时猝死风险较低。射血分数<0.40的患者仍有较高的猝死风险，应考虑进行额外或替代治疗。
