Predictors of efficacy of amiodarone and characteristics of recurrence of arrhythmia in patients with sustained ventricular tachycardia and coronary artery disease.
Predictors of efficacy of amiodarone and characteristics of recurrence of arrhythmia in patients with sustained ventricular tachycardia and coronary artery disease.
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胺碘酮疗效的预测因素以及持续性室性心动过速和冠状动脉疾病患者心律失常复发的特征。
DOI：
10.1161/01.cir.76.4.802
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发表时间：
1987
期刊：
影响因子：
37.8
通讯作者：
DiMarco,JP
中科院分区：
文献类型：
--
作者：
Zhu,J;Haines,DE;Lerman,BB;DiMarco,JP
在长期口服胺碘酮治疗期间，系列电药理学测试对预测长期药物疗效以及心律失常复发特征的价值存在争议。连续104例冠状动脉疾病和持续性室性快速性心律失常（VT）患者在无药物状态下接受了初始电生理（EP）评价，并在胺碘酮负荷期25 +/- 14天（平均值+/- SD）后再次接受EP评价。26例患者（25%）在胺碘酮治疗期间未发生可诱导的室性快速性心律失常（VT对照组），而其余78例患者（VT非对照组）持续存在可诱导的心律失常。在17.4 ± 13.7个月的随访中，VT对照组中有2例患者发生VT复发或猝死，而VT非对照组中有21例VT复发和8例心源性猝死（36个月的精算事件率分别为0.11和0.56，p = 0.0065）。将室性心动过速非对照组的这21例患者的室性心动过速复发周期长度与最终EP测试时观察到的周期长度进行比较。证明了显著的线性相关性（r = 0.76，p = 0.0001）。对室性心动过速非对照组患者进行的亚组分析显示，EP没有预测结局的因素，包括诱发室性心动过速的周期长度。然而，在随访期间突然死亡的患者新发或恶化的充血性心力衰竭的患病率（75%）高于VT复发患者（19%）或未发生心力衰竭事件的患者（29%）（p <0.02）。
The value of serial electropharmacologic testing during long-term oral amiodarone therapy for prediction of long-term drug efficacy as well as characteristics of arrhythmia recurrence is controversial. One-hundred four consecutive patients with coronary artery disease and sustained ventricular tachyarrhythmias (VT) underwent initial electrophysiologic (EP) evaluation in the drug-free state and again after an amiodarone loading period of 25 +/- 14 days (mean +/- SD). Twenty-six patients (25%) had no inducible ventricular tachyarrhythmia during therapy with amiodarone (VT control group), whereas arrhythmia inducibility persisted in the remaining 78 patients (VT noncontrol group). During 17.4 +/- 13.7 months of follow-up, two patients in the VT control group either had VT recurrence or died suddenly compared with 21 VT recurrences and eight sudden cardiac deaths in the VT noncontrol group (actuarial event rates at 36 months of 0.11 and 0.56, respectively, p = .0065). The cycle lengths of recurrent VT in these 21 patients in the VT noncontrol group were compared with those observed at final EP testing. A significant linear correlation was demonstrated (r = .76, p = .0001). Subgroup analysis of patients in the VT noncontrol group showed no EP predictors of outcome, including cycle length of induced VT. However, patients dying suddenly during the follow-up period had a higher prevalence of new or worsening congestive heart failure (75%) compared with patients with VT recurrence (19%) or those with no arrhythmic event (29%) (p less than .02).2off