Relation of acute antiarrhythmic drug efficacy to left ventricular function in coronary artery disease

• Published in: The American journal of cardiology Vol. 61; no. 13; pp. 1050 - 1055
• Main Authors: Meissner, Marc D., Kay, Harold R., Horowitz, Leonard N., Spielman, Scott R., Greenspan, Allan M., Kutalek, Steven P.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.1988; Elsevier
• Subjects: Administration, Oral; Adult; Aged; Aged, 80 and over; Anti-Arrhythmia Agents - administration & dosage; Anti-Arrhythmia Agents - blood; Anti-Arrhythmia Agents - pharmacology; Anti-Arrhythmia Agents - therapeutic use; Antiarythmic agents; Arrhythmias, Cardiac - drug therapy; Arrhythmias, Cardiac - physiopathology; Biological and medical sciences; Cardiac Pacing, Artificial; Cardiovascular system; Clinical Trials as Topic; Coronary Disease - blood; Coronary Disease - drug therapy; Coronary Disease - physiopathology; Female; Heart - physiopathology; Heart Ventricles - physiopathology; Humans; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Prognosis; Stroke Volume - drug effects; Tachycardia - blood; Tachycardia - drug therapy; Tachycardia - physiopathology; Ventricular Fibrillation - blood; Ventricular Fibrillation - drug therapy; Ventricular Fibrillation - physiopathology; Therapeutic efficiency; Human; Chemotherapy; Arrhythmia; Cardiovascular disease; Paroxysmal ventricular tachycardia; Left ventricle performance; Coronary heart disease; Posology; Antiarrhythmia agent; Ventricular fibrillation
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/0002-9149(88)90124-5

This study assessed the relation between acute antiarrhythmic drug efficacy and left ventricular (LV) function in patients with sustained ventricular tachyarrhythmias, that is, sustained ventricular tachycardia (VT) or ventricular fibrillation (VF). Electrophysiologic studies (n = 560) were performed in 201 patients, separated for analysis into <30 and ≥30% ejection fraction groups. Coronary artery disease was present in all patients. The 8 acute antiarrhythmic regimens were procainamide, quinidlne, mexiletine, mexiletine + type 1A agent, flecainide or indecainide, amiodarone, amiodarone + type 1A and “miscellaneous” agents. At least 1 successful acute antiarrhythmic regimen was found in 47% of patients and in a significantly greater proportion of patients with ejection fraction ≥30% (52 of 81 = 64%) than in those with ejection fraction < 30% (43 of 120 = 36%, p < 0.001). Drug trials were successful (initiation of < 15 repetitive ventricular responses) in 32% of patients with ejection fraction ≥30% versus 19% of those with ejection fraction < 30% (p < 0.001). There were no statistically significant differences between the 2 ejection fraction groups in type of heart disease, acute antiarrhythmic dosages or mean serum drug levels. A logistic regression analysis incorporating multiple clinically relevant factors found that ejection fraction was the only factor that correlated significantly with drug success or failure (p < 0.002). Acute antiarrhythmic drug efficacy relates to LV function per se or to other pathophysiologic mechanisms of which ejection fraction may be a marker.