A comparison of seven antiarrhythmic drugs in patients with ventricular tachyarrhythmias. Electrophysiologic Study versus Electrocardiographic Monitoring Investigators.
A comparison of seven antiarrhythmic drugs in patients with ventricular tachyarrhythmias. Electrophysiologic Study versus Electrocardiographic Monitoring Investigators.
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室性快速心律失常患者七种抗心律失常药物的比较。
DOI：
10.1056/nejm199308123290702
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发表时间：
1993
期刊：
影响因子：
--
通讯作者：
Mason,JW
中科院分区：
文献类型：
--
作者：
Mason,JW
背景各种抗心律失常药物治疗室性快速心律失常的相对疗效尚不清楚。本研究探讨了丙咪嗪，美西律，pirmenol，普鲁卡因胺，普罗帕酮，奎尼丁，和索他洛尔在室性快速性心律失常的患者谁参加了电生理研究与心电图monitoringtrial.MethodsPatients被随机分配到两个策略之一：电生理研究或霍尔特监测与运动试验进行一系列测试的疗效的7种抗心律失常药物。然后在符合条件的患者中随机测试这七种药物的疗效。制表显示所有486例随机化受试者在初始药物滴定期间药物疗效和药物不良反应的预测频率。患者接受了第一种抗疟疾药物的长期治疗，该药物在药物测试的基础上预测是有效的。心律失常，死亡和药物不良反应的复发在长期随访记录的296例患者中，抗心律失常药物预测是effective.ResultsIn的电生理研究组，谁预测药物疗效的患者的百分比是较高的索他洛尔（35%）比其他药物（16%，P<0.001）。动态心电图监测组药物间差异无统计学意义。在接受索他洛尔治疗的患者中，发生药物不良反应的患者比例最低。两种治疗方案中任何一种预测药物疗效后，接受索他洛尔治疗的患者心律失常复发的精算概率均显著低于接受其他药物治疗的患者（风险比为0.43; 95%可信区间为0.29 ~ 0.62; P<0.001）。与其他药物联合治疗相比，索他洛尔组任何原因死亡（风险比为0.50; 95%置信区间为0.30 ~ 0.80; P = 0.004）、心脏原因死亡（0.50; P = 0.02）和心律失常死亡（0.50; P = 0.04）的风险较低。索他洛尔组预测有效、有效和耐受的累积患者百分比高于其他6种抗心律失常药物组（P<0.001）。结论索他洛尔在预防死亡和心律失常复发方面优于其他6种抗心律失常药物。在与本研究相似的患者中，如果抗心律失常药物治疗用于预防室性快速性心律失常复发，索他洛尔治疗并通过霍尔特监测评估其潜在疗效是合理的初始策略。
BackgroundThe relative efficacies of various antiarrhythmic drugs in the treatment of ventricular tachyarrhythmias are not well known. This study examined the effectiveness of imipramine, mexiletine, pirmenol, procainamide, propafenone, quinidine, and sotalol in patients with ventricular tachyarrhythmias who were enrolled in the Electrophysiologic Study versus Electrocardiographic Monitoring trial.MethodsPatients were randomly assigned to undergo serial testing of the efficacy of the seven antiarrhythmic drugs by one of two strategies: electrophysiologic study or Holter monitoring together with exercise testing. The seven drugs were then tested for efficacy in random order in patients who were eligible to receive them. The frequencies of predictions of drug efficacy and of adverse drug effects during the initial drug titration were tabulated for all 486 randomized subjects. Patients received long-term treatment with the first antiarrhythmic drug that was predicted to be effective on the basis of drug testing. Recurrences of arrhythmia, deaths, and adverse drug effects during long-term follow-up were recorded for the 296 patients in whom an antiarrhythmic drug was predicted to be effective.ResultsIn the electrophysiologic-study group, the percentage of patients who had predictions of drug efficacy was higher with sotalol (35 percent) than with the other drugs (16 percent, P<0.001). There was no significant difference among the drugs in the Holter-monitoring group. The percentage of patients with adverse drug effects was lowest among those receiving sotalol. The actuarial probability of a recurrence of arrhythmia after a prediction of drug efficacy by either strategy was significantly lower for patients treated with sotalol than for patients treated with the other drugs (risk ratio, 0.43; 95 percent confidence interval, 0.29 to 0.62; P<0.001). With sotalol, as compared with the other drugs combined, there were lower risks of death from any cause (risk ratio, 0.50; 95 percent confidence interval, 0.30 to 0.80; P = 0.004), death from cardiac causes (0.50; P = 0.02), and death from arrhythmia (0.50; P = 0.04). The cumulative percentage of patients in whom a drug was predicted to be effective and in whom it remained effective and tolerated was higher for sotalol than for the other drugs (P<0.001).ConclusionsSotalol was more effective than the other six antiarrhythmic drugs in preventing death and recurrences of arrhythmia. In patients similar to those in this study, if antiarrhythmic-drug therapy is to be used to prevent recurrences of ventricular tachyarrhythmias, treatment with sotalol and assessment of its potential efficacy by Holter monitoring are a reasonable initial strategy.