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Characteristics of recurrent ventricular fibrillation associated with inferolateral early repolarization role of drug therapy.

AbstractOBJECTIVES:
Our purpose was to evaluate the efficacy of antiarrhythmic drugs (AADs) in recurrent ventricular fibrillation (VF) associated with inferolateral early repolarization pattern on the electrocardiogram.
BACKGROUND:
Although an implantable cardioverter-defibrillator is the treatment of choice, additional AADs may be necessary to prevent frequent episodes of VF and reduce implantable cardioverter-defibrillator shock burden or as a lifesaving therapy in electrical storms.
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.
AuthorsMichel 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
JournalJournal of the American College of Cardiology (J Am Coll Cardiol) Vol. 53 Issue 7 Pg. 612-9 (Feb 17 2009) ISSN: 1558-3597 [Electronic] United States
PMID19215837 (Publication Type: Clinical Trial, Journal Article)
Chemical References
  • Anti-Arrhythmia Agents
  • Quinidine
  • Isoproterenol
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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