Evaluation of flecainide acetate in the management of patients at high risk of sudden cardiac death.
Evaluation of flecainide acetate in the management of patients at high risk of sudden cardiac death.
复制标题
醋酸氟卡尼治疗心源性猝死高危患者的评价。
DOI：
10.1016/0002-9149(84)90513-7
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发表时间：
1984
期刊：
影响因子：
--
通讯作者：
Ord,SE
中科院分区：
文献类型：
--
作者：
Reid,PR;Griffith,LS;Platia,EV;Ord,SE
醋酸氟卡尼的临床疗效在36例患者（29例男性和7例女性，平均年龄56岁）中进行了评价，这些患者既往使用抗真菌药物治疗失败。所有患者在霍尔特心电图记录中都记录了室性心动过速，36例患者中有31例（86%）有晕厥或需要心肺复苏，或两者兼而有之。血管造影结果显示22例（61%）有明显的冠状动脉疾病，14例（39%）有原发性左心室功能不全，左心室射血分数为0.39 ± 0.4。患者接受的氟卡尼平均剂量为302 ± 76 mg/天。随访时间为101 ± 156天。霍尔特监测显示，36例患者中有32例（89%）室性心动过速完全消除，只有2例患者因非心脏副作用（麻木、视力模糊和共济失调）而停用氟卡尼。然而，5例患者因心脏副作用（2例预防性效应，1例窦性心动过缓，1例完全性房室传导阻滞和1例新发左束分支传导阻滞）而停用该药，10例患者在氟卡尼治疗期间死亡（1例脑卒中，3例充血性心力衰竭和6例持续性室性心动过速）。比较死亡者与未死亡者的一般心脏特征，发现射血分数显著较低（0.24 ± 0.1 vs 0.45 ± 0.1，p < 0.05），氟卡尼剂量显著较高（350 ± 85 vs 276 ± 59 mg/d，p < 0.05）。这些结果表明，氟卡尼可以抑制室性心动过速的患者在高风险的危及生命的室性快速性心律失常。但是，对于左心室功能严重抑制的患者应谨慎使用。
The clinical effectiveness of flecainide acetate was evaluated in 36 patients (29 male and 7 female, average age 56 years) in whom therapy with previous antiarrhythmic agents had failed. All patients had documented ventricular tachycardia on Holter electrocardiographic recording and 31 of 36 (86%) had had syncope or required cardiopulmonary resuscitation, or both. Angiographic findings demonstrated significant coronary artery disease in 22 (61%) and primary left ventricular dysfunction in 14 (39%), with a left ventricular ejection of 0.39 ± 0.4. Patients were treated with an average flecainide dose of 302 ± 76 mg/day. The follow-up time was 101 ± 156 days. Thirty-two of 36 patients (89%) had complete elimination of ventricular tachycardia from Holter monitoring and only 2 patients had flecainide discontinued because of noncardiac side effects (numbness, blurred vision and ataxia). However, the drug was subsequently discontinued in 5 patients because of cardiac side effects (proarrhythmic effect in 2, sinus bradycardia in 1, complete atrioventricular block in 1 and new left bundle branch block in 1) and 10 patients died during flecainide therapy (1 with cerebral stroke, 3 with congestive heart failure and 6 with incessant ventricular tachycardia). A comparison of the general cardiac features of those who died with those who did not revealed a significantly lower ejection fraction (0.24 ± 0.1 vs 0.45 ± 0.1, p < 0.05) and a significantly higher flecainide dose (350 ± 85 versus 276 ± 59 mg/day, p < 0.05). These results demonstrate that flecainide can suppress ventricular tachycardia in patients at high risk of life-threatening ventricular tachyarrhythmias. However, it should be used with caution in patients with severely depressed left ventricular function.