Abstract | OBJECTIVES: BACKGROUND: METHODS: From a multicenter cohort of 122 patients (90 male subjects, age 37 +/- 12 years) with idiopathic VF and early repolarization abnormality in the inferolateral leads, we selected all patients with more than 3 episodes of VF (multiple) including those with electrical storms (> or =3 VF in 24 h). The choice of AAD was decided by individual physicians. Follow-up data were obtained for all patients using monitoring with implantable defibrillator. Successful oral AAD was defined as elimination of all recurrences of VF with a minimal follow-up period of 12 months. RESULTS: Multiple episodes of VF were observed in 33 (27%) patients. Electrical storms (34 +/- 47 episodes) occurred in 16 and were unresponsive to beta-blockers (11 of 11), lidocaine/ mexiletine (9 of 9), and verapamil (3 of 3), while amiodarone was partially effective (3 of 10). In contrast, isoproterenol infusion immediately suppressed electrical storms in 7 of 7 patients. Over a follow-up of 69 +/- 58 months, oral AADs were poorly effective in preventing recurrent VF: beta-blockers (2 of 16), verapamil (0 of 4), mexiletine (0 of 4), amiodarone (1 of 7), and class 1C AADs (2 of 9). Quinidine was successful in 9 of 9 patients, decreasing recurrent VF from 33 +/- 35 episodes to nil for 25 +/- 18 months. In addition, quinidine restored a normal electrocardiogram. CONCLUSIONS: Multiple recurrences of VF occurred in 27% of patients with early repolarization abnormality and may be life threatening. Isoproterenol in acute cases and quinidine in chronic cases are effective AADs.
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Authors | Michel Haïssaguerre, Frederic Sacher, Akihiko Nogami, Nohiriro Komiya, Anne Bernard, Vincent Probst, Sinikka Yli-Mayry, Pascal Defaye, Yoshifusa Aizawa, Robert Frank, Roberto Mantovan, Riccardo Cappato, Christian Wolpert, Antoine Leenhardt, Luc de Roy, Hein Heidbuchel, Isabel Deisenhofer, Thomas Arentz, Jean-Luc Pasquié, Rukshen Weerasooriya, Meleze Hocini, Pierre Jais, Nicolas Derval, Pierre Bordachar, Jacques Clémenty |
Journal | Journal of the American College of Cardiology
(J Am Coll Cardiol)
Vol. 53
Issue 7
Pg. 612-619
(Feb 17 2009)
ISSN: 1558-3597 [Electronic] United States |
PMID | 19215837
(Publication Type: Clinical Trial, Journal Article)
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Chemical References |
- Anti-Arrhythmia Agents
- Quinidine
- Isoproterenol
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Topics |
- Adolescent
- Adult
- Anti-Arrhythmia Agents
(pharmacology, therapeutic use)
- Death, Sudden, Cardiac
(etiology, prevention & control)
- Defibrillators, Implantable
- Female
- Humans
- Isoproterenol
(pharmacology)
- Male
- Middle Aged
- Quinidine
(pharmacology)
- Recurrence
- Treatment Outcome
- Ventricular Fibrillation
(complications, drug therapy, physiopathology)
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