Singh B N
Cardiology Section, VA Affairs Medical Center, West Los Angeles, CA 90073, USA.
Pharmacotherapy. 1997 Mar-Apr;17(2 Pt 2):56S-64S; discussion 89S-91S.
When treating life-threatening ventricular arrhythmias such as symptomatic ventricular tachycardia and ventricular fibrillation (VT/VF), the nature of the arrhythmia must be precisely defined and the approach must be tailored to it. For hemodynamically unstable ventricular arrhythmias, DC cardioversion or high-energy defibrillation remains the approach of choice. Determining the specific role of intravenous drugs in acute conversion of VT/VF and the most appropriate long-term therapy (pharmacologic or nonpharmacologic) to prevent recurrence can be difficult. Pharmacologic conversion of stable VT/VF presents an even greater challenge, as the role of lidocaine considered the first-line agent for many decades, is now being reevaluated. Lidocaine appears to be effective in converting no more than 20% of stable VTs, compared with 70% for intravenous sotalol. The precise efficacies of parenteral procainamide, beta-blockers, and newer class III agents, including intravenous amiodarone, remain to be defined; however, intravenous amiodarone, available recently, can control unstable, recurrent VT/VF that is resistant to lidocaine or procainamide. A standard regimen of concomitant intravenous and oral amiodarone may be given for rapid and sustained control, and allows oral amiodarone to be continued in a significant number of patients.
在治疗危及生命的室性心律失常，如症状性室性心动过速和心室颤动（VT/VF）时，必须精确界定心律失常的性质，并据此采取相应的治疗方法。对于血流动力学不稳定的室性心律失常，直流电复律或高能除颤仍是首选的治疗方法。确定静脉用药在VT/VF急性转复中的具体作用以及预防复发的最合适的长期治疗（药物或非药物）可能具有一定难度。稳定型VT/VF的药物转复面临更大挑战，因为曾被视为一线药物数十年的利多卡因，如今正在重新评估。与静脉注射索他洛尔转复稳定型VT的成功率达70%相比，利多卡因转复稳定型VT的成功率似乎不超过20%。胃肠外给药的普鲁卡因胺、β受体阻滞剂以及包括静脉注射胺碘酮在内的新型III类药物的确切疗效仍有待明确；然而，近期可用的静脉注射胺碘酮能够控制对利多卡因或普鲁卡因胺耐药的不稳定、复发性VT/VF。可采用静脉和口服胺碘酮联合的标准方案以实现快速、持续控制，并使大量患者能够继续口服胺碘酮治疗。
