Reiffel J A, Reiter M J, Blitzer M
Department of Medicine, Columbia University College of Physicians & Surgeons, New York, New York, USA.
Am J Cardiol. 1998 Aug 20;82(4A):31I-40I. doi: 10.1016/s0002-9149(98)00470-6.
Ischemic heart disease is the most frequent cardiac abnormality in patients with sustained or nonsustained ventricular tachyarrhythmias. The goals of therapy in such patients are to decrease the severity and incidence of symptoms and prolong life. In this article, we review the current views on antiarrhythmic drug therapy and an implantable cardioverter-defibrillator (ICD) in patients with ischemic heart disease. The importance of beta blockade as part of the therapy is emphasized. In addition, the superiority of sotalol and amiodarone over class I drugs, the benefits of combined treatment with amiodarone and a beta blocker, and the impact and limitations of current trials comparing the effectiveness of drug therapy with that of an ICD are all considered. Also discussed is the combined use of an antiarrhythmic drug and an ICD. In this approach sotalol is generally the agent of choice, with amiodarone the second choice.
缺血性心脏病是持续性或非持续性室性心律失常患者中最常见的心脏异常。这类患者的治疗目标是减轻症状的严重程度和发生率，并延长寿命。在本文中，我们回顾了关于缺血性心脏病患者抗心律失常药物治疗和植入式心脏复律除颤器（ICD）的当前观点。强调了β受体阻滞剂作为治疗一部分的重要性。此外，还考虑了索他洛尔和胺碘酮相对于I类药物的优越性、胺碘酮与β受体阻滞剂联合治疗的益处，以及当前比较药物治疗与ICD有效性的试验的影响和局限性。还讨论了抗心律失常药物与ICD的联合使用。在这种方法中，索他洛尔通常是首选药物，胺碘酮是第二选择。
