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首页> 美国卫生研究院文献>Clinical Cardiology >Long‐term low‐dose amiodarone therapy in the management of ventricular and supraventricular tachyarrhythmias: Efficacy and safety
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Long‐term low‐dose amiodarone therapy in the management of ventricular and supraventricular tachyarrhythmias: Efficacy and safety

机译：长期小剂量胺碘酮治疗心室和室上性快速性心律失常的疗效和安全性

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Background: Amiodarone hydrochloride has been in use for two decades for the control of ventricular and supraventricular arrhythmias. Established and emerging evidence indicates that amiodarone has an antiarrhythmic efficacy superior to that of most other drugs. Hypothesis: The study was undertaken to evaluate the efficacy and acceptability of low‐dose amiodarone therapy in the long‐term management of supraventricular and ventricular tachyarrhythmias. Methods: A total of 124 patients with symptomatic drug‐refractory or life‐threatening arrhythmias managed with low‐dose oral amiodarone therapy over a 10‐year period was analyzed retrospectively. Of these, 45 patients (36%) had ventricular arrhythmias, 52 (42%) had atrial arrhythmias, and 27 (22%) had atrioventricular reentry tachycardia. Loading doses of amiodarone 600 mg daily for 1 week were administered for supraventricular arrhythmias and 600–1200 mg daily for 2 weeks for ventricular arrhythmias. Maintenance daily doses were 194 ± 48 and 206 ± 55 mg, respectively. Mean treatment duration was 32 ± 28 months, with 326.3 patient years of therapy. Results: Of 39 patients with sustained ventricular tachyarrhythmias, the actuarial incidence of satisfactory arrhythmia control (absence of sudden cardiac death or nonfatal arrhythmia recurrence) was 78% at 1 year and 71 % at 2 years. Satisfactory control of supraventricular arrhythmias (mean ventricular rate < 100/min with significant symptomatic improvement for sustained atrial arrhythmias and < 1 attack per year for paroxysmal atrial or atrioventricular arrhythmias) was achieved in 73, 65, and 62% of patients at 1, 2, and 3 years, respectively. The cumulative incidence of amiodarone‐related adverse effects was 5.8 per 100 patient years, with drug withdrawal required in 12 patients (9.7%). Fifteen patients had thyroid dysfunction, 2 had hepatic toxicity, and 1 developed nonfatal pulmonary fibrosis. Overall, the incidence of successful use of amiodarone (satisfactory arrhythmia control and freedom from side effects) was 67, 59, and 53% at 1, 2, and 3 years, respectively. Conclusions: The results of this study suggest that the efficacy of low‐dose amiodarone therapy in the management of serious ventricular and supraventricular arrhythmias would be similar to those achieved with higher doses, but with a much more acceptable side effect profile.
机译：背景：盐酸胺碘酮已被用于控制室性和室上性心律失常已有二十年的历史。已有的和新兴的证据表明胺碘酮的抗心律失常功效优于大多数其他药物。假设：本研究旨在评估小剂量胺碘酮治疗在室上性和室性快速性心律失常的长期治疗中的疗效和可接受性。方法：回顾性分析10年来使用低剂量口服胺碘酮治疗的124例症状性药物难治性或危及生命的心律失常患者。其中45例（36％）患有室性心律不齐，52例（42％）患有房性心律不齐，27例（22％）患有房室折返性心动过速。对于室上性心律失常，每天服用600毫克胺碘酮，持续2周，对于室性心律失常，每天服用600 1200毫克胺碘酮。维持日剂量分别为194±48和206±55 mg。平均治疗持续时间为32±28个月，接受326.3患者年的治疗。结果：在39例持续性室性心律失常患者中，满意的心律失常控制（无猝死或非致命性心律失常复发）的精算发生率在1年时为78％，在2年时为71％。在73％，6​​5％和62％的患者中，1、2和2％的患者实现了对室上性心律失常的满意控制（平均心室率<100 / min，症状显着改善，持续性心律失常，发作性房性或房室性心律失常每年<1次发作）。 ，和3年。胺碘酮相关不良反应的累积发生率是每100患者年5.8，其中12名患者需要停药（9.7％）。甲状腺功能异常15例，肝毒性2例，非致命性肺纤维化1例。总体而言，成功使用胺碘酮（令人满意的心律失常控制和无副作用）的发生率分别在第1年，第2年和第3年分别为67％，59％和53％。结论：这项研究的结果表明，小剂量胺碘酮治疗严重心室和室上性心律失常的疗效与高剂量相似，但副作用要大得多。

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