Skip to main content
Log in

Adjunctive therapy for recurrent ventricular tachycardia in patients with implantable cardioverter defibrillators

  • Invasive Electrophysiology and Pacing
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Implantable cardioverter defibrillators (ICDs) are now the mainstay of therapy in patients with sustained ventricular tachycardia (VT), ventricular fibrillation, resuscitated sudden cardiac death, or certain high-risk markers for these arrhythmic events. Although ICDs in such patients can be life-saving, they can impair quality of life when painful or frequent discharges occur or when residual VT symptoms recur prior to delivery of ICD therapies. As such, antiarrhythmic drugs often are employed in an attempt to reduce the triggering tachyarrhythmic events. Recently, studies with β-blockers, sotalol, amiodarone, and the investigational agent azimilide have been performed to objectify the efficacy, benefits, or risks of such therapies when administered to patients with ICDs. This review describes the considerations important to the use of these therapies in ICD patients and the results and applicability of these investigative studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Reiffel JA:Drug and drug-device therapy in heart failure patients in the post-COMET and SCD-HeFT era.J Cardiovasc Therapeut 2005,10:545–558.

    Google Scholar 

  2. Duray G, Israel CW, Hohnloser SH:Recent primary prevention implantable cardioverter defibrillator trials.Curr Opin Cardiol 2006,21:15–19.

    PubMed  Google Scholar 

  3. Steinberg JS, Martins J, Sadanandan S, et al.:Antiarrhythmic drug use in the implantable defibrillator arm of the AVID study.Am Heart J 2001,142:520–529.

    Article  PubMed  CAS  Google Scholar 

  4. DiMarco JP:Implantable cardioverter-debrillators.N Engl J Med 2003,49:1836–1847.

    Article  Google Scholar 

  5. Reiter MJ, Reiffel JA:Importance of beta blockade in the therapy of serious ventricular arrhythmias.Am J Cardiol 1998,82:91–191.

    Article  Google Scholar 

  6. Reiffel JA:Drug and drug-device therapy in heart failure patient in the post-COMET and SCD-HeFT era.J Cardiovasc Therapeut 2005,10:545–558.

    Google Scholar 

  7. Reiffel JA:Practical algorithms for pharmacologic management of the post myocardial infarction patient.Clin Cardiol 2005,28(Suppl 1):I-28–I-37.

    Google Scholar 

  8. Exner DV, Reiffel JA, Epstein AE, et al.:Beta blocker use and survival in patients with ventricular fibrillation or symptomatic ventricular tachycardia.J Am Coll Cardiol 1999,34:325–333.

    Article  PubMed  CAS  Google Scholar 

  9. Brodine WN, Tung RT, Lee JK, et al.:Effects of beta-blockers on implantable cardioverter defibrillator therapy and survival in the patients with ischemic cardiomyopathy [from the Multicenter Automatic Defibrillator Implantation Trial—II].Am J Cardiol 2005,96:691–695.

    Article  PubMed  CAS  Google Scholar 

  10. Reiffel JA, Reiter MJ, Blitzer M:Antiarrhythmic drugs and devices for the management of ventricular tachyarrhythmias in ischemic heart disease.Am J Cardiol 1998,82:311–401.

    Article  Google Scholar 

  11. Kowey P, Reiffel JA:Section on pharmacokinetics, antiarrhythmic drugs, proarrhythmia. Electrophysiology Self Assessment Program [EPSAP II]. Bethesda, MD: American College of Cardiology; 2000.

    Google Scholar 

  12. Reiffel JA, Curtis AB:Antiarrhythmic drugs. American College of Cardiology Self Assessment Program [ACCSAP], version 6, book 4. Bethesda, MD: American College of Cardiology; 2005:15–53.

    Google Scholar 

  13. Reiffel JA, Hahn E, Hartz V, et al.:Sotalol for ventricular tachyarrhythmias: beta-blocking and class III contributions, and relative efficacy versus class I drugs after prior drug failure.Am J Cardiol 1997,79:1048–1053.

    Article  PubMed  CAS  Google Scholar 

  14. Pacifico A, Hohnloser SH, Williams JH, et al.:Prevention of implantable defibrillator shocks by treatment with sotalol.N Engl J Med 1999,340:1855–1862.

    Article  PubMed  CAS  Google Scholar 

  15. Seidl K, Hauer B, Schwick NG, et al.:Comparison of metoprolol and sotalol in preventing ventricular tachyarrhythmias after the implantation of a cardioverter/defibrillator.Am J Cardiol 1998,82:744–748.

    Article  PubMed  CAS  Google Scholar 

  16. Reiffel JA, Naccarelli GV:Antiarrhythmic drug therapy for atrial fibrillation: are the guidelines guiding clinical practice? Clin Cardiol 2006,29:97–102.

    Article  PubMed  Google Scholar 

  17. Of major importance Connolly SJ, Dorian P, Roberts R, et al.:Comparison of beta blockers, amiodarone plus beta blockers, or sotalol for prevention of shocks from implantable cardioverter defibrillators: the OPTIC study: a randomized trial.JAMA 2006,295:165–171. A significant prospective trial comparing the risks, benefits, and tolerance of multiple AAD in conjunction with ICD therapy.

    Article  PubMed  CAS  Google Scholar 

  18. Hohnloser SH, Dorian P, Roberts R, et al.:Effect of amiodarone and sotalol on ventricular defibrillation threshold: the Optimal Pharmacological Therapy in Cardioverter Defibrillator Patients (OPTIC) trial.Circulation 2006,114:104–109.

    Article  PubMed  CAS  Google Scholar 

  19. Boutitie F, Boissel JP, Connolly SJ, et al.:Amiodarone interactions with beta blockers: analysis of the merged EMIAT and CAMIAT databases.Circulation 1999,99:2268–2275.

    PubMed  CAS  Google Scholar 

  20. Singer I, Al-Khalididi H, Niazi I, et al.:Azimilide decreases recurrent ventricular tachyarrhythmias in patients with implantable cardioverter defibrillators.J Am Coll Cardiol 2004,43:39–43.

    Article  PubMed  CAS  Google Scholar 

  21. Of major importance Dorian P, Borggrefe M, Al-Khalidi HR, et al.:Placebocontrolled, randomized clinical trial of azimilide for prevention of ventricular tachyarrhythmias in patients with an implantable cardioverter defibrillator.Circulation 2004,110:3646–3654. An extremely well-done trial assessing the effect of azimilide in ICD patients; this trial is privotal in the Food and Drug Administration application for approval of azimilide for this indication.

    Article  PubMed  CAS  Google Scholar 

  22. Credner SC, Klingenheben T, Mauss O, et al.:Electrical storm in patients with transvenous implantable cardioverterdefibrillators: incidence, management, and prognostic implications.J Am Coll Cardiol 1998,32:1909–1915.

    Article  PubMed  CAS  Google Scholar 

  23. Hohnloser SH, Al-Khalidi HR, Pratt CM, et al.:Electrical storm in patients with an implantable defibrillator: incidence, features, and preventive therapy: insights from a randomized trial.Eur Heart J 2006,37:3027–3032.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to James A. Reiffel MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Reiffel, J.A. Adjunctive therapy for recurrent ventricular tachycardia in patients with implantable cardioverter defibrillators. Curr Cardiol Rep 9, 381–386 (2007). https://doi.org/10.1007/BF02938365

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02938365

Keywords

Navigation