Clinical characteristics of patients with ventricular fibrillation during antiarrhythmic drug therapy.
Clinical characteristics of patients with ventricular fibrillation during antiarrhythmic drug therapy.
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DOI：
10.1056/nejm198808043190501
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发表时间：
1988-08
期刊：
影响因子：
--
通讯作者：
Joseph D. Minardo;J. Heger;W. Miles;D. Zipes;E. Prystowsky
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文献类型：
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作者：
Joseph D. Minardo;J. Heger;W. Miles;D. Zipes;E. Prystowsky
我们回顾性研究了28例患者，其中38次在抗心律失常药物治疗期间新发室颤。其中26例患者在奎尼丁、普鲁卡因胺或丙吡胺单药治疗期间发生室颤，与对照组62例患者进行比较，对照组62例患者接受类似的室性心律失常治疗，但在治疗期间没有发生室颤。室颤前的中位治疗持续时间为3天。研究组的左心室射血分数低于对照组（0.29 vs. 0.43; P <0.0001），研究组中洋地黄和利尿剂的伴随治疗更常见。研究组的基线QT间期（经心率校正）略长于对照组（0.47 vs. 0.44; P <0.005），尽管两组在药物治疗期间的QT间期延长程度相似。13例接受多次抗心律失常药物试验的患者中有4例（31%）反复发作室颤。6名患者在平均随访18个月后突然死亡--4名患者接受了抗癫痫治疗，2名患者没有接受治疗。我们的结论是，药物相关性室颤是一个早期事件，有可能增加其复发的风险与随后的抗心律失常药物的试验，左心室功能障碍和伴随治疗洋地黄和利尿剂可能使患者易患这种并发症。
We retrospectively studied 28 patients with 38 episodes of newly occurring ventricular fibrillation during antiarrhythmic drug therapy. Twenty-six of these patients, who had ventricular fibrillation during single-drug therapy with quinidine, procainamide, or disopyramide, were compared with a control group of 62 patients who had been treated similarly for ventricular arrhythmias but did not have ventricular fibrillation during treatment. The median duration of therapy before ventricular fibrillation was three days. The left ventricular ejection fraction of the study group was lower than that of the control group (0.29 vs. 0.43; P less than 0.0001), and concomitant treatment with digitalis and diuretic agents was more common in the study group. The base-line QT interval (corrected for heart rate) was slightly longer in the study group than in the controls (0.47 vs. 0.44; P less than 0.005), although both groups had similar degrees of QT prolongation during drug therapy. Four of 13 patients (31 percent) who underwent multiple trials of antiarrhythmic drugs had recurrent episodes of ventricular fibrillation. Six patients died suddenly after a mean follow-up of 18 months--four who were receiving antiarrhythmic therapy and two who were not. We conclude that drug-associated ventricular fibrillation is an early event, that there may be an increased risk of its recurrence with subsequent trials of antiarrhythmic drugs, and that left ventricular dysfunction and concomitant therapy with digitalis and diuretic agents may predispose patients to this complication.