Treatment of ventricular arrhythmias by United States cardiologists: a survey before the Cardiac Arrhythmia Suppression Trial results were available.
Treatment of ventricular arrhythmias by United States cardiologists: a survey before the Cardiac Arrhythmia Suppression Trial results were available.
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美国心脏病专家对室性心律失常的治疗：心律失常抑制试验结果公布之前的一项调查。
DOI：
10.1016/0002-9149(90)90023-t
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发表时间：
1990
期刊：
影响因子：
--
通讯作者：
Jeffrey L. Anderson
中科院分区：
文献类型：
--
作者：
J. Morganroth;J. Bigger;Jeffrey L. Anderson
为了确定美国心脏病专家的执业习惯和室性心律失常的治疗，从12000名心脏病专家中随机抽取1000人发送了一份预测问卷。在随访过程后，252人做出回应，其中18%是学术机构，29%是医院，53%是办公室。对抗心律失常药物治疗室性心律失常的态度受心脏病的存在和严重程度、症状的存在和室性心律失常类型的影响。在这项调查中，只有1%的心脏病专家治疗无症状室性早搏复合物且无心脏病的患者，但有17%的心脏病专家治疗存在非持续性室性心动过速的患者。当无症状性室性过早复合体患者存在冠状动脉疾病并左心室功能障碍时，心脏病专家的治愈率增加到38%。任何心脏疾病和症状性室性心律失常的存在将治疗率提高到80%至100%。大约50%的应答医生使用抗心律失常药物治疗与心律失常抑制试验研究人群相当的患者。受体阻滞剂是最常见的抗心律失常药物，被选为室性心律失常新患者最合适的初始治疗药物。尽管没有心脏病专家认为胺碘酮适合用于良性或潜在恶性室性心律失常的新患者，但多达33%至43%的心脏病专家会将胺碘酮用于此类心律失常的难治性患者，这一反应与该药物已批准的标签相矛盾。不到一半的心脏病专家认识到奎尼丁、普鲁卡因胺和托卡因胺具有很高的潜在器官毒性。心脏病专家认为，IA类和IC类抗心律失常药物对潜在恶性室性心律失常患者同样具有促心律失常作用。只有约25%至50%的心脏病专家在医院内开始使用抗心律失常药物。63%的心脏病专家一直使用电生理测试来评估持续性室性心动过速；33%的患者从未对潜在的恶性室性心律失常进行过此类检测。在这些结果中，没有基于回应的心脏病专家的地理位置的差异。因此，在抗心律失常药物的毒性、电生理测试的使用以及院内与院外药物起始方面存在明显缺乏共识的问题。在调查期间，大多数心脏病专家治疗无症状和有症状的潜在恶性室性心律失常患者，尽管心律失常抑制试验的中期结果表明重新考虑对这类患者的治疗。
To define the practice habits of United States cardiologists and the treatment of ventricular arrhythmias, a random sample of 1,000 of 12,000 cardiologists was sent a pretested questionnaire. After follow-up procedures, 252 responded, of which 18% were academically-based, 29% were hospital-based and 53% were office-based. Attitudes about antiarrhythmic drug therapy for the treatment of ventricular arrhythmias were influenced by the presence and severity of cardiac disease, the presence of symptoms and the type of ventricular arrhythmias. In this survey, only 1% of cardiologists treated patients with asymptomatic ventricular premature complexes and no heart disease, but 17% treated such patients if unsustained ventricular tachycardia was present. The treatment rate among cardiologists increased to 38% when coronary artery disease with left ventricular dysfunction was present in patients with asymptomatic ventricular premature complexes. The presence of any cardiac disease and symptomatic ventricular arrhythmias increased the treatment rate to 80 to 100%. Approximately 50% of responding physicians treated patients comparable to the Cardiac Arrhythmia Suppression Trial study population with antiarrhythmic drugs. Beta blockers were the most common antiarrhythmic drug class chosen as the most appropriate initial therapy in new patients with ventricular arrhythmias. Whereas no cardiologists thought that amiodarone was appropriate to initiate in new patients with benign or potentially malignant ventricular arrhythmias, as many as 33 to 43% of cardiologists would use amiodarone for refractory patients with such arrhythmias, a response contradictory to the approved labeling for this drug.Less than one half of cardiologists recognize the high potential organ toxicity for quinidine, procainamide and tocainide. Cardiologists believed that antiarrhythmic agents with class IA and IC action were equally proarrhythmic in patients with potentially malignant ventricular arrhythmias. Antiarrhythmic drugs were initiated only in-hospital by about 25 to 50% of cardiologists. Etectrophysiologic testing was always used by 63% of cardiologists for evaluation of sustained ventricular tachycardia; 33% never used such testing for patients with potentially malignant ventricular arrhythmias. There were no differences in these results based on the geographic location of the responding cardiologists.Thus, significant lack of consensus exists on the toxicity of antiarrhythmic drugs, use of electrophysiologic testing and in- versus out-of-hospital drug initiation. At the time of the survey, most cardiologists treated patients with asymptomatic and symptomatic potentially malignant ventricular arrhythmias, although the interim results of the Cardiac Arrhythmia Suppression Trial indicate reconsideration for therapy in such patients.
恩卡尼、氟卡尼、丙咪嗪和莫雷西嗪对急性心肌梗死后一年内室性心律失常的影响：CAPS。
DOI：
10.1016/0002-9149(88)90754-0
发表时间：
1988
期刊：
The American journal of cardiology
影响因子：
--
作者：
CardiacArrhythmiaPilotStudy(CAPS)Investigators
通讯作者：
CardiacArrhythmiaPilotStudy(CAPS)Investigators