Levine J H, Massumi A, Scheinman M M, Winkle R A, Platia E V, Chilson D A, Gomes A, Woosley R L
Arrhythmia Service, St. Francis Hospital, Roslyn, New York 11576, USA.
J Am Coll Cardiol. 1996 Jan;27(1):67-75. doi: 10.1016/0735-1097(95)00427-0.
We sought to determine the response rate and safety of intravenous amiodarone in patients with ventricular tachyarrhythmias refractory to standard therapies.
Numerous small retrospective reports suggest a response of refractory ventricular tachyarrhythmias to intravenous amiodarone, yet no controlled prospective trials exist.
Two hundred seventy-three patients with recurrent hypotensive ventricular tachyarrhythmias refractory to lidocaine, procainamide and bretylium were randomized to receive one of three doses of intravenous amiodarone: 525, 1,050 or 2,100 mg/24 h (mean [+/- SE] dose 743.7 +/- 418.7, 1,175.2 +/- 483.7, 1,921.2 +/- 688.8 mg, respectively) by continuous infusion over 24 h.
Of the 273 patients, 110 (40.3% response rate) survived 24 h without another hypotensive ventricular tachyarrhythmic event while being treated with intravenous amiodarone as a single agent (primary end point). A significant difference in the time to first recurrence of ventricular tachyarrhythmia (post hoc analysis) over the first 12 h was observed when the combined 1,050- and 2,100-mg dose groups were compared with the 525-mg dose group (p = 0.046). The number of supplemental (150 mg) infusions of intravenous amiodarone (given for breakthrough destabilizing tachyarrhythmias) during hours 0 to 6 (prespecified secondary end point) was significantly greater in the 525-mg dose group than in the 2,100-mg dose group (1.09 +/- 1.57 vs. 0.51 +/- 0.97, p = 0.0043). However, there was no clear dose-response relation observed in this trial with respect to success rates (primary end point), time to first recurrence of tachyarrhythmia (post hoc analysis) or mortality (secondary end point) over 24 h.
Intravenous amiodarone is a relatively safe therapy for ventricular tachyarrhythmias refractory to other medications.
我们试图确定静脉注射胺碘酮对标准治疗无效的室性快速心律失常患者的有效率和安全性。
大量小型回顾性报告提示难治性室性快速心律失常对静脉注射胺碘酮有反应，但尚无对照前瞻性试验。
273例对利多卡因、普鲁卡因胺和溴苄铵治疗无效的复发性低血压性室性快速心律失常患者被随机分为接受三种剂量静脉注射胺碘酮之一：525、1050或2100mg/24小时（平均[±标准误]剂量分别为743.7±418.7、1175.2±483.7、1921.2±688.8mg），通过24小时持续输注给药。
273例患者中，110例（有效率40.3%）在作为单一药物接受静脉注射胺碘酮治疗期间存活24小时且未发生另一次低血压性室性快速心律失常事件（主要终点）。当将1050mg和2100mg联合剂量组与525mg剂量组比较时，观察到在最初12小时内心室快速心律失常首次复发时间（事后分析）有显著差异（p = 0.046）。在0至6小时期间（预先设定的次要终点），525mg剂量组静脉注射胺碘酮补充输注（用于治疗突破性不稳定快速心律失常）的次数显著多于2100mg剂量组（1.09±1.57对0.51±0.97，p = 0.0043）。然而，在本试验中，就24小时内的成功率（主要终点）、快速心律失常首次复发时间（事后分析）或死亡率（次要终点）而言，未观察到明确的剂量反应关系。
静脉注射胺碘酮对于对其他药物治疗无效的室性快速心律失常是一种相对安全的治疗方法。
