Le Heuzey J Y, Copie X, Iliou M C, Guize L
Service de cardiologie A, hôpital Broussais, Paris.
Arch Mal Coeur Vaiss. 1998 Apr;91 Spec No 2:39-42.
Antiarrhythmic therapy is a special case in the therapeutic strategy of acute myocardial infarction. There are very few controlled therapeutic trials and its use is mainly based on clinical experience rather than on scientific evidence. The most common arrhythmias requiring treatment in acute myocardial infarction are atrial fibrillation, ventricular tachycardia and ventricular fibrillation. There is no evidence to support the use Class I antiarrhythmics. Lidocain may be used in some cases. Similarly, contradictory results have been reported with the use of magnesium salts and the general tendency is not to use this ion in acute myocardial infarction. The most commonly used antiarrhythmic agents are the betablockers and amiodarone. The general principles of treatment should be respected: all antiarrhythmic drugs have negative inotropic effects, apart from digitalis. All antiarrhythmics may have a proarrhythmic effect including digitalis, especially in this clinical context. Whenever possible, continuous intravenous infusions are to be preferred to bolus injections. In addition, and when possible, electrotherapy is preferable to antiarrhythmic drug therapy. Finally, a number of cardiac arrhythmias observed in acute myocardial infarction should be "respected" or treated by electrotherapy but never by antiarrhythmic drugs.
抗心律失常治疗是急性心肌梗死治疗策略中的一个特殊情况。对照治疗试验非常少，其应用主要基于临床经验而非科学证据。急性心肌梗死中需要治疗的最常见心律失常是心房颤动、室性心动过速和心室颤动。没有证据支持使用Ⅰ类抗心律失常药物。在某些情况下可使用利多卡因。同样，关于镁盐的使用也有相互矛盾的报道，一般倾向于在急性心肌梗死中不使用这种离子。最常用的抗心律失常药物是β受体阻滞剂和胺碘酮。应遵循治疗的一般原则：除洋地黄外，所有抗心律失常药物都有负性肌力作用。所有抗心律失常药物都可能有致心律失常作用，包括洋地黄，尤其是在这种临床情况下。只要有可能，持续静脉输注优于大剂量注射。此外，在可能的情况下，电疗法优于抗心律失常药物治疗。最后，急性心肌梗死中观察到的一些心律失常应予以“观察”或用电疗法治疗，但绝不用抗心律失常药物治疗。
