INDUCTION OF MALIGNANT VENTRICULAR TACHYCARDIA ON AMIODARONE IN HCM PATIENTS

尽管已有报道称胺碘酮可提高急性髓细胞白血病患者的存活率。 肥厚型心肌病(HCM)的危险患者，我们注意到 高度症状性肥厚型心肌炎患者的意外死亡率 用这种强效的抗心律失常药物治疗。这项研究 报告14例程序性电刺激(PS)的结果 肥厚性心肌炎患者-10名患者有晕厥症状，4名患者有晕厥症状 Preyncope。所有患者均有非持续性室性心动过速。 (Vt)动态心电图监测。在胺碘酮治疗之前，持续 11例诱发室性心动过速。10例患者的室速为 多态的。在胺碘酮上，持续的室速是由 在所有14名患者中，PS方案的侵袭性显著降低。在……里面 12例为单形性室速。尽管VT速度较慢 在胺碘酮治疗的所有患者中，室性心动过速的诱发率与 有明显的高血压，需要迅速终止。我们的结论是 在大多数肥厚性心肌病患者中，胺碘酮有助于诱导 血流动力学不稳定的持续性单形性室速及其应用 具有潜在危险，需要PS进行评估。

Although amiodarone has been reported to improve survival in at- risk patients with hypertrophic cardiomyopathy (HCM), we have noted an unexpected mortality rate in highly symptomatic HCM patients treated with this potent antiarrhythmic medication. The study reports the results of programed electrical stimulation (PS) in 14 HCM patients - 10 patients presented with syncope and 4 with presyncope. All patients had nonsustained ventricular tachycardia (VT) on Holter monitoring. Before amiodarone therapy, sustained VT was induced in 11 patients. In 10 patients the VT was polymorphic. On amiodarone, sustained VT was induced with significantly less aggressive PS protocol in all 14 patients. In 12 patients this was monomorphic VT. Although the VT was slower on amiodarone, in all patients induction of VT was associated with marked hypertension requiring rapid termination. We conclude that in most HCM patients amiodarone facilitates induction of a hemodynamically unstable sustained monomorphic VT and thus its use is potentially dangerous and requires evaluation by PS.