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Proarrhythmic Response to Antiarrhythmic Drug as a Risk Factor for Sudden Cardiac Death in Patients with Ischemic Heart Disease
Author(s) -
TRUSZGLUZA MARIA,
GIEC LESZEK,
DABROWSKI ANDRZEJ,
KUCH JERZY,
PASYK STANISLAW,
PIWOWARSKA WIESTLAWA,
PRACKA HALINA,
SADOWSKI ZYGMUNT,
WODNIECKI JAN
Publication year - 1991
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1991.tb02795.x
Subject(s) - medicine , proarrhythmia , cardiology , amiodarone , sudden cardiac death , mexiletine , disopyramide , myocardial infarction , ventricular fibrillation , ventricular tachycardia , sudden death , cardioversion , anesthesia , atrial fibrillation
The prognostic significance of arrhythmogenicc response to an antiarrhythmic drug was studied. In 782 palients with ischemic heart disease (IHD) and frequent and/or complex ventricular premature boats (VPBs), 1,041 drug tests guided by 24‐hour Holter monitoring were conducted. The following drugs were assessed: beta blockers, disopyramide, mexiletine, amiodarone. Proarrhythmia was defined as: (1) > 4‐fold increase in VPBs, (2) > 10‐fold increase in repetitive forms, or (3) new occurrence of ventricular tachycardia or ventricular fibrillation (VT/VF). During a follow‐up of 1–49 months fmean 22) patients were treated with anfiarrhythmic drugs found to be safe in control Holter monitoring, Proarrhythmic effects were observed in 8.4% of patients. No drug was completely free of this type of reaction. In long‐term observation, cardiac death and sudden death occurred in 5.3 and 32 patients, respectively. With actuarial analysis (Kaplan‐Meier method, log‐rank test) there was a significant difference in cardiac death (P < 0.01) and sudden death rate (P < 0.05) of proarrhythmia (+) compared with proarrhythmia (‐) patients at 1 year (11% vs 4%, 7% vs 3%) and 3 years (24% vs 11%, 16% vs 7%). Proarrhythmic response was an independent risk factor apart from myocardial infarction, VT/VF, ejection fraction < 40% and QT c > 440 msec. Arrhythmogenic response to antiarrhythmic drugs seems to be en additional predictor of sudden death in IHD.