Hampton J R
Br J Hosp Med. 1977 Feb;17(2):160-2, 165, 167-72.
The first and most important aspect of the management of a cardiac arrhythmia is its precise identification, and intracardiac recordings should be made in cases of doubt. When confronted with a patient with an arrhythmia the first decision is whether it needs treating at all. If it does the next problem is to decide whether to begin with electrical or pharmacological treatment, and here the important feature is the clinical state of the patient: the more ill the patient and the larger the haemodynamic disturbance, the greater the relative indication for electrical (cardioversion or pacing) therapy. Although there has been some progress in the understanding of the pathological physiology of arrhythmias and attempts have been made to rationalize the classification of cardioactive drugs, these sciences have not so far provided information of clinical value. The drug therapy of arrhythmias is largely arbitrary, but few drugs are involved. The most important thing of all is for an individual clinician to become familiar with the most significant of these drugs and not to indulge in polypharmacy, because all antiarrhythmic drugs can lead to either depression or overexcitation of the myocardium.
心律失常管理的首要且最重要的方面是对其进行精确识别，在存在疑问的情况下应进行心内记录。当面对一名心律失常患者时，首要决策是其是否根本需要治疗。如果需要治疗，接下来的问题是决定是开始进行电治疗还是药物治疗，在此重要特征是患者的临床状态：患者病情越重且血流动力学紊乱越严重，电（复律或起搏）治疗的相对指征就越大。尽管在心律失常病理生理学的理解方面已取得一些进展，并且已尝试使心血管活性药物的分类合理化，但到目前为止这些学科尚未提供具有临床价值的信息。心律失常的药物治疗很大程度上是随意的，但涉及的药物很少。最重要的是个体临床医生要熟悉这些药物中最重要的药物，不要滥用多种药物，因为所有抗心律失常药物都可能导致心肌抑制或过度兴奋。
