Melichercik J, Schöls W, Beyer T, Schweizer M, Brachmann J, Kübler W
Deutsches Herzzentrum Baden Klinik für Innere Medizin und Kardiologie, Lahr.
Z Kardiol. 1996 May;85(5):319-25.
Of the traditional antiarrhythmic agents administered in the treatment of ventricular tachycardias, those belonging to Class III are most commonly used. However, some ventricular tachycardias displaying special clinical, electrocardiographic and/or electrophysiologic characteristics have been successfully treated with calcium antagonists. Otherwise, Class IV antiarrhythmic agents are primarily used in the treatment of supraventricular tachyarrhythmias. It is reasonable to suspect that calcium-dependent phenomena underlie ventricular tachyarrhythmias in a number of patients. Verapamil-sensitive sustained left ventricular tachycardias represent a typical example. Sufficient response to calcium antagonists has also been demonstrated for exercise-induced ventricular tachycardias and repetitive monomorphic ventricular tachycardias. Characteristically, these arrhythmias occur in young patients with no structural heart disease. The long-term prognosis of these patients is in fact very good, but because of intrusive symptoms, pharmacological or nonpharmacological (radiofrequency ablation) treatment is often indicated. Through correct diagnosis and implementation of a short- and long-term therapy with calcium antagonists, and excellent alternative to the potentially harmful therapy with Class I and Class III antiarrhythmic agents can be offered.
在用于治疗室性心动过速的传统抗心律失常药物中，Ⅲ类药物最为常用。然而，一些具有特殊临床、心电图和/或电生理特征的室性心动过速已成功用钙拮抗剂治疗。否则，Ⅳ类抗心律失常药物主要用于治疗室上性快速心律失常。有理由怀疑，许多患者的室性快速心律失常的基础是钙依赖性现象。对维拉帕米敏感的持续性左室性心动过速就是一个典型例子。运动诱发的室性心动过速和重复性单形性室性心动过速对钙拮抗剂也有充分反应。这些心律失常的特点是发生在无结构性心脏病的年轻患者中。这些患者的长期预后实际上非常好，但由于有侵入性症状，通常需要进行药物或非药物（射频消融）治疗。通过正确诊断并实施钙拮抗剂的短期和长期治疗，可以提供一种优于使用Ⅰ类和Ⅲ类抗心律失常药物的潜在有害治疗的极佳替代方案。
