Kowey P R
Cardiovascular Division, The Lankenau Hospital, Wynnewood, PA 19096, USA.
Can J Cardiol. 1996 Apr;12 Suppl B:3B-8B; discussion 27B-28B.
Electrical storm, the most lethal of all cardiac arrhythmias, is defined as incessant or frequently recurrent ventricular fibrillation, or hemodynamically destabilizing ventricular tachycardia. Electrical storm typically develops in older men with coronary artery disease, in the setting of a acute myocardial infarction or following cardiac surgery. Treatment of electrical storm with conventional antiarrhythmic drugs is seldom effective. Amiodarone, an anti-arrhythmic agent with established efficacy in the treatment of a variety of atrial and ventricular tachyarrhythmias, is now available as an intravenous formulation in hospitals. Three recent studies have examined the effect of intravenous amiodarone in the management of electrical storm. The studies, performed in critically ill patients, found amiodarone to be effective in the treatment of these serious arrhythmias. Two of the studies compared different dose ranges for intravenous amiodarone, while one study compared amiodarone to intravenous bretylium. The investigators found amiodarone to be as effective as bretylium, and to have significantly fewer adverse effects requiring drug discontinuation. Side effects of intravenous amiodarone included hypotension and bradycardia, both of which were managed by reducing the rate of the infusion. Proarrhythmia, defined as torsade de pointes or new onset ventricular fibrillation, was infrequently seen in the studies.
电风暴是所有心律失常中最致命的一种，定义为持续性或频繁复发的心室颤动，或血流动力学不稳定的室性心动过速。电风暴通常发生在患有冠状动脉疾病的老年男性中，在急性心肌梗死期间或心脏手术后。用传统抗心律失常药物治疗电风暴很少有效。胺碘酮是一种在治疗各种房性和室性快速心律失常方面已证实有效的抗心律失常药物，现在医院中有静脉制剂。最近的三项研究探讨了静脉注射胺碘酮在治疗电风暴中的作用。这些在危重病患者中进行的研究发现，胺碘酮对治疗这些严重心律失常有效。其中两项研究比较了静脉注射胺碘酮的不同剂量范围，而一项研究将胺碘酮与静脉注射溴苄铵进行了比较。研究人员发现胺碘酮与溴苄铵效果相当，且因不良反应而停药的情况明显较少。静脉注射胺碘酮的副作用包括低血压和心动过缓，这两种情况都通过降低输注速度来处理。在研究中很少见到定义为尖端扭转型室速或新发心室颤动的致心律失常作用。
