Skip to main content
SpringerLink
Log in

The potential for antiarrhythmic drugs to reduce mortality from sudden cardiac death

  • Chapter
Sudden Cardiac Death

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 110))

  • 49 Accesses

Abstract

In this article, we will discuss the evidence that antiarrhythmic drug treatment improves outcome, (i.e., prevents symptomatic ventricular arrhythmias and sudden cardiac death) and how to evaluate antiarrhythmic drug therapy for patients with malignant ventricular arrhythmias. Then, we will discuss previously completed and ongoing trials of antiarrhythmic drug treatment in patients with potentially malignant ventricular arrhythmias. We will not discuss the potential of beta adrenergic blocking drugs to prevent sudden cardiac death because Dr. Van Durme has discussed this in detail elsewhere [55] We will separate the ventricular arrhythmias into malignant and potentially malignant (see Morganroth [22]).

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Fisher JD, Cohen HL, Mehra R, Altschuler H, Escher DJW, Furman S: Cardiac pacing and pacemakers, II. Serial electrophsiologic-pharmacologic testing for control of recurrent tachyarrhythmias. Am Heart J 1997; 93: 658–68.

    Article  Google Scholar 

  2. Horowitz LN, Josephson ME, Farshidi A, Spielman SR, Michaelson EL, Greenspan AM: Recurrent sustained ventricular tachycardia. 3: Role of the electrophysiologic study in selection of antiarrhythmic regimens. Circulation 1978; 58: 986–97.

    PubMed  CAS  Google Scholar 

  3. Mason JW, Winkle RA: Electrode-catheter arrhythmia induction in the selection and assessment of antiarrhythmic drug therapy for recurrent ventricular tachycardia. Circulation 1978; 58: 971–85.

    PubMed  CAS  Google Scholar 

  4. Mason JW, Winkle RA: Accuracy of the ventricular tachycardia induction study for predicting long-term efficacy and inefficacy of antiarrhythmic drugs. N Engl J Med 1980; 303: 1073–7.

    Article  PubMed  CAS  Google Scholar 

  5. Horowitz LN, Josephson ME, Kastor JA: Intracardiac electrophysiologic studies as a method for the optimization of drug therapy in chronic ventricular arrhythmia. Prog Cardiovasc Dis 1980; 23: 81–98.

    Article  PubMed  CAS  Google Scholar 

  6. Ruskin JN, DiMarco JP, Garan H: Out-of-hospital cardiac arrest: electrophysiologic observations and selection of long-term antiarrhythmic therapy. N Engl J Med 1980; 303: 707–13.

    Article  Google Scholar 

  7. Swerdlow CD, Winkle RA, Mason JW: Determinants of survival in patients with ventricular tachyarrhythmias. N Engl J Med 1983; 308: 1436–42.

    Article  PubMed  CAS  Google Scholar 

  8. Benditt DG, Benson DW, Klein GJ, Pritzker MR, Kriett JM, Anderson RW: Prevention of recurrent sudden cardiac arrest: role of provocative electropharmacologic testing. J Am Coll Cardiol 1983; 2: 418–25.

    Article  PubMed  CAS  Google Scholar 

  9. McGovern B, Garan H, Malacoff RF, DiMarco JP, Grant G, Sellers TD, Ruskin JN: Long term clinical out-come of ventricular tachycardia or fibrillation treated with amiodarone. Am J Cardiol 1984; 53: 1558–63.

    Article  PubMed  CAS  Google Scholar 

  10. Rae AP, Greenspan AM, Spielman SR, Sokoloff NM, Webb CR, Kay HR, Horowitz LN: Antiarrhythmic drug efficacy for ventricular tachyarrhythmias associated with coronary artery disease as assessed by electrophysiologic studies. Am J Cardiol 1985; 55: 1494–9.

    Article  PubMed  CAS  Google Scholar 

  11. Horowitz LN, Greenspan AM, Spielman SR, Webb CR, Morganroth J, Rotmensch H, Sokoloff NM, Rae AP, Segal BL, Kay HR: Usefulness of electrophysiologic testing in evaluation of amiodarone therapy for sustained ventricular tachyarrhythmias associated with coronary heart disease. Am J Cardiol 1985; 55: 367–372.

    Article  PubMed  CAS  Google Scholar 

  12. Waller TJ, Kay HR, Spielman SR, Kutlaek SP, Greenspan AM, Horowitz LN: Reduction in sudden death and total mortality by antiarrhythmic therapy evaluated by electrophysiologic drug testing: criteria of efficacy in patients with sustained ventricular tachyarrhythmia. J Am Coll Cardiol 1987; 10: 83–9.

    Article  PubMed  CAS  Google Scholar 

  13. Graboys TB, Lown B, Podrid PJ, DeSilva R: Long-term survival of patients with malignant ventricular arrhythmia treated with antiarrhythmic drugs. Am J Cardiol 1982; 50: 437–43.

    Article  PubMed  CAS  Google Scholar 

  14. Hoffman A, Schutz E, White R, Follath F, Burckhardt D: Suppression of high-grade ventricular ectopic activity by antiarrhythmic drug treatment as a marker for survival in patients with chronic coronary artery disease. Am Heart J 1984; 107: 1103–1108.

    Article  Google Scholar 

  15. Vlay SC, Kaltman LH, Reid PR: Prognostic assessment of survivors of ventricular tachycardia and ventricular fibrillation with ambulatory monitoring. Am J Cardiol 1984; 54: 87–90.

    Article  PubMed  CAS  Google Scholar 

  16. Hohnloser SN, Raeder EA, Podrid PJ, Graboys TB, Lown B: Predictors of antiarrhythmic drug efficacy in patients with malignant ventricular tachyarrhythmias. Am Heart J 1987; 114: 1–7.

    Article  PubMed  CAS  Google Scholar 

  17. Lampert S, Lown B, Graboys TB, Podrid PJ, Blatt CM: Determinants of survival in patients with malignant ventricular arrhythmias associated with coronary artery disease. Am J Cardiol 1988; 61: 791–7.

    Article  PubMed  CAS  Google Scholar 

  18. Bigger JT Jr: Holter/exercise and electrophysiologic methods for evaluating drug therapy for malignant ventricular arrhythmias: do we need both models? In: Cardiac Arrhythmias: New Therapeutic Drugs and Devices, Morganroth J Moore EN eds, Martinus Nijhoff, Boston, 1985, 211–221. Am J Cardiol 1988; 61: 501–9.

    Article  Google Scholar 

  19. Breithardt G, Borggrefe M, Seipel L: Selection of optimal drug treatment of ventricular tachycardia by programmed electrical stimulation of the heart. In: Clinical Aspects of Life-Threatening Arrhythmias, Greenberg HM, Kulbertus HE, Moss AJ, Schwartz PJ eds, Ann NY Acad Sci 1984; 427: 49–65.

    Article  PubMed  CAS  Google Scholar 

  20. Bigger JT Jr: Cardiac arrhythmias. Chapter 45 in Cecil’s Textbook of Medicine, Wyngaarden JB and Smith HK eds, W.B. Saunders Co., Philadelphia, 1988, pp. 250–274.

    Google Scholar 

  21. Kienzle MG, Martins JB, Wendt DJ, Constantin L, Hopson R, McCue ML: Enhanced efficacy of oral sotalol for sustained ventricular tachycardia refractory to type I antiarrhythmic drugs. Am J Cardiol 1988; 61: 1012–7.

    Article  PubMed  CAS  Google Scholar 

  22. Morganroth J, Anderson JL, Gentzkow GD: Classification by type of ventricular arrhythmia predicts frequency of adverse cardiac events from flecainide. J Am Coll Cardiol 1986; 8: 607–615.

    Article  PubMed  CAS  Google Scholar 

  23. de Paola AAV, Horowitz LN, Morganroth J, Senior S, Spielman SR, Greenspan AM, Kay HR: Influence of left ventricular dysfunction on flecainide therapy. J Am Coll Cardiol 1987; 9: 163–168.

    Article  PubMed  Google Scholar 

  24. Mason JW: Amiodarone. N Engl J Med 1987; 316: 455–66.

    Article  CAS  Google Scholar 

  25. Swerdlow CD, Pederson, J: Prospective comparison of Holter monitoring and electrophysiologic study in patients with coronary artery disease and sustained ventricular tachyarrhythmias. Am J Cardiol 1985; 56: 577–80.

    Article  PubMed  CAS  Google Scholar 

  26. Kim SG, Seiden SW, Felder SD, Waspe LE, Fisher JD: Is programmed stimulation of value in predicting the long-term success of antiarrhythmic therapy for ventricular tachycardias? N Engl J Med 1986; 315: 356–362.

    Article  PubMed  CAS  Google Scholar 

  27. Freedman RA, Swerdlow CD, Echt DS, Winkle RA, Soderholm Difatte V, Mason JW: Facilitation of ventricular tachyarrhythmia induction by isoproterenol. Am J Cardiol 1984; 54: 756–70.

    Article  Google Scholar 

  28. McGovern B, Ruskin JN: The efficacy of amiodarone for ventricular arrhythmias can be predicted with clinical electrophysiologic studies. Int J Cardiol 1983; 3: 71–76.

    Article  PubMed  CAS  Google Scholar 

  29. Borggrefe M, Breithardt G: Predictive value of electrophysiologic testing in the treatment of drug-refractory ventricular arrhythmias with amiodarone. Eur Heart J 1986; 7: 735–742.

    PubMed  CAS  Google Scholar 

  30. Naccarelli GV, Fineberg NS, Zipes DP, Heger JJ, Duncan G, Prystowsky EN: Amiodarone: risk factors for recurrence of symptomatic ventricular tachycardia identified at electrophysiologic study. J Am Coll Cardiol 1985; 6: 814–821.

    Article  PubMed  CAS  Google Scholar 

  31. Fisher JD, Kim SG, Waspe LE, Johnston DR: Amiodarone: value of programmed electrical stimulation and Holter monitoring. (review) PACE 1986; 9: 422–435.

    PubMed  CAS  Google Scholar 

  32. Kadish AH, Buxton AE, Waxman HL, Flores B, Josephson ME, Marchlinski FE: Usefulness of electrophysiologic study to determine the clinical tolerance of arrhythmia recurrences during amiodarone therapy. J Am Coll Cardiol 1987; 10: 90–96.

    Article  PubMed  CAS  Google Scholar 

  33. Schmitt C, Brachmann J, Waldecker B, Rizos I, Senges J, Kubler W: Amiodarone in patients with recurrent sustained ventricular tachyarrhythmias: results of programmed electrical stimulation and long-term clinical outcome in chronic treatment. Am Heart J 1987; 114: 279–283.

    Article  PubMed  CAS  Google Scholar 

  34. Mitchell LB, Duff HJ, Manyari DE, Wyse DG: A randomized clinical trial of the noninvasive and invasive approaches to drug therapy of ventricular tachycardia. N Engl J Med 1987; 317: 1681–1687.

    Article  PubMed  CAS  Google Scholar 

  35. Ruberman W, Weinblatt E, Goldberg JD, Frank CW, Shapiro S: Ventricular premature beats and mortality after myocardial infarction. N Engl J Med 1977; 297: 750–757.

    Article  PubMed  CAS  Google Scholar 

  36. Moss AI, Davis HT, DeCamilla J, Bayer LW: Ventricular ectopic beats and their relation to sudden and nonsudden cardiac death after myocardial infarction. Circulation 1978; 60: 998–1003.

    Google Scholar 

  37. Bigger JT Jr, Weld FM, Rolnitzky LM: The prevalence and significance of ventricular tachycardia detected by ambulatory ECG recording in the late hospital phase of acute myocardial infarction. Am J Cardiol. 1981; 48: 815–823.

    Article  PubMed  Google Scholar 

  38. Kleiger RE, Miller JP, Thanavaro S, Marin TF, Province MA, Oliver GC: Relationship between clinical features of acute myocardial infarction and ventricular runs two weeks to one year following infarction. Circulation 1981; 63: 64–70.

    Article  PubMed  CAS  Google Scholar 

  39. The Multicenter Postinfarction Research Group: Risk stratification and survival after myocardial infarction. N Engl J Med 1983; 309: 331–336.

    Article  Google Scholar 

  40. Hinkle LE, Thaler IT: Clinical classification of cardiac deaths. Circulation 1982; 65: 457–464.

    Article  PubMed  Google Scholar 

  41. Bigger JT Jr, Fleiss JL, Kleiger R, Miller JP, Rolnitzky LM and The Multicenter Post-Infarction Group: The relationship between ventricular arrhythmias, left ventricular dysfunction and mortality in the 2 years after myocardial infarction. Circulation 1984; 69: 250–258.

    Article  PubMed  Google Scholar 

  42. Bigger JT Jr, Fleiss JL, Kleiger, RE, Miller JP, Rolnitzky LM, and The Multicenter Post Infarction Research Group: Prevalence, characteristics and significance of ventricular tachycardia detected by 24-hour continuous electrocardiographic recordings in the late hospital phase of acute myocardial infarction. Am J Cardiol 1986; 58: 1151–1160.

    Article  PubMed  Google Scholar 

  43. Marcus FI, Cobb LA, Edwards JE, Kuller L, Moss AJ, Bigger JT Jr, Fleiss JL, Rolnitzky LM, Serokman R, and the Multicenter Postinfarction Research Group: Mechanism of death and prevalence of myocardial ischemic symptoms in the terminal event after acute myocardial infarction. Am J Cardiol 1988; 61: 8–15.

    Article  PubMed  CAS  Google Scholar 

  44. Bigger JT Jr: Relation between left ventricular dysfunction and ventricular arrhythmias after myocardial infarction. Am J Cardiol 1986; 57: 8b-14b.

    Article  PubMed  Google Scholar 

  45. Mukharji J, Rude RE, Poole WK, Gustafson N, Thomas LJ Jr, Strauss HW, Jaffe AS, Muller JE, Roberts R, Raabe DS Jr, Croft CH, Passamani E, Braunwald E, Willerson JT and the MILIS Study Group: Risk factors for sudden death after acute myocardial infarction: two years follow-up. Am J Cardiol 1984; 54: 31–6.

    Article  PubMed  CAS  Google Scholar 

  46. May GS, Eberlein KA, Furberg CD, Passamani ER, DeMets DL: Secondary prevention after myocardial infarction: a review of long-term trials. Prog Cardiovasc Dis 1982; 24: 331–52.

    Article  PubMed  CAS  Google Scholar 

  47. Furberg CD: Effect of antiarrhythmic drugs on mortality after myocardial infarction. Am J Cardiol 1983; 52: 32C–36C.

    Article  PubMed  CAS  Google Scholar 

  48. Collaborative Group: Phenytoin after recovery from myocardial infarction. Controlled trial in 568 patients. Lancet 1971; 2: 1055–57.

    Google Scholar 

  49. Peter T, Ross D, Duffield A, Luxton M, Harper R, Hunt D, Sloman G: Effect on survival after myocardial infarction of long-term treatment with phenytoin. Br Heart J 1978; 40: 1356–60.

    Article  PubMed  CAS  Google Scholar 

  50. Ryden L, Amman K, Conradson TB, Hofvendahl S, Mortensen O, Smedgard P: Prophylaxis of ventricular tachyarrhythmias with intravenous and oral tocainide in patients with and recovering from acute myocardial infarction. Am Heart J 1980; 1006–12.

    Google Scholar 

  51. Bastian BC, Macfarlane PW, McLauchlan JH, Ballantyne D, Clark R, Hillis WS, Rae AP, Hutton I: A prospective randomized trial of tocainide in patients following myocardial infarction. Am Heart J 1980; 100: 1017–22.

    Article  PubMed  CAS  Google Scholar 

  52. Chamberlain DA, Jewitt DE, Julian DG, Campbell RWF, Boyle DMcC, Shanks RG: Oral mexiletine in high-risk patients after myocardial infarction. Lancet 1980; 2: 1324–27.

    Article  PubMed  CAS  Google Scholar 

  53. IMPACT Research Group: International Mexiletine and Placebo Antiarrhythmic Coronary Trial (IMPACT): II. Results from 24-hour electrocardiograms. IMPACT Research Group. Eur Heart J 1986; 7: 749–59.

    Google Scholar 

  54. IMPACT Research Group: International mexiletine and placebo antiarrhythmic coronary trial: I. Report on arrhythmia and other findings Impact Research Group. J Am Coll Cardiol 1984; 4: 1148–63.

    Article  Google Scholar 

  55. Hagemeijer F, Glaser B, van Durme JP, Bogaert M: Design of a study to evaluate drug therapy of serious ventricular rhythm disturbances after an acute myocardial infarction. Eur J Cardiol 1977; 6: 299–310.

    PubMed  CAS  Google Scholar 

  56. Gottlieb SH, Achuff SC, Mellits D, Gerstenblith G, Baughman KL, Becker L, Chandra NC, Henley S, Humphries J O’N, Heck C, Kennedy MM, Weisfeldt ML, Reid PR: Prophylactic antiarrhythmic therapy of high-risk survivors of myocardial infarction: lower mortality at 1 month but not at 1 year. Circulation 1987; 75: 792–9.

    Article  PubMed  CAS  Google Scholar 

  57. The CAPS Investigators: The Cardiac Arrhythmia Pilot Study. Am J Cardiol 1986; 57: 91–95.

    Article  Google Scholar 

  58. The CAPS Investigators: Recruitment and baseline description of patients in the Cardiac Arrhythmia Pilot Study. Am J Cardiol 1988; 61: 704–13.

    Article  Google Scholar 

  59. The CAPS Investigators: Effects of Encainide, Flecainide, Imipramine, and Moricizine on Ventricular Arrhythmias during the Year after Acute Myocardial Infarction: CAPS Am J Cardiol 1988; 61: 501–9.

    Google Scholar 

  60. Bigger JT Jr: Methodology for clinical trials with antiarrhythmic drugs to prevent cardiac death: US experience. Cardiology 1987; 74 (suppl 2): 40–56.

    Article  PubMed  Google Scholar 

Download references

Authors
  1. J. Thomas Bigger Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Cardiology, Hospital de la Santa Creu i Sant Pau, University of Barcelona, Avda. San Antonio Maria Claret 167, 08025, Barcelona, Spain

    A. Bayés de Luna

  2. Department of Cardiology, Academic Hospital, University of Limburg, P.O. Box 1918, 6201 BX, Maastricht, The Netherlands

    P. Brugada

  3. Research Group Spanish Trail on Sudden Death, Hospital ‘La Fe’, Av de Campanar 21, 46009, Valencia, Spain

    J. Cosin Aguilar

  4. Department of Cardiology and Coronary Care Unit, Hospital Clinico-University of Barcelona, Barcelona, Spain

    F. Navarro-Lopez

Rights and permissions

Reprints and permissions

Copyright information

© 1991 Kluwer Academic Publishers

About this chapter

Cite this chapter

Bigger, J.T. (1991). The potential for antiarrhythmic drugs to reduce mortality from sudden cardiac death. In: de Luna, A.B., Brugada, P., Aguilar, J.C., Navarro-Lopez, F. (eds) Sudden Cardiac Death. Developments in Cardiovascular Medicine, vol 110. Springer, Dordrecht. https://doi.org/10.1007/978-94-009-0573-3_5

Download citation

  • DOI: https://doi.org/10.1007/978-94-009-0573-3_5

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-6745-4

  • Online ISBN: 978-94-009-0573-3

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation