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Practical aspects and news in pharmacological treatment of arrhythmias


Authors: P. Heinc
Published in: Kardiol Rev Int Med 2005, 7(1): 10-16

Overview

In the field of arrhythmias it is possible to follow a continuous development of pharmacological treatment and above all non-pharmacological treatment. The review of treatment of bradycardias with essential indications for electrophysiological examination and radiofrequency ablation is given separately. Electrophysiological and clinical aspects of new antiarrhythmics are set forth. A practical review of diagnostics, general fundamentals of pharmacotherapy of arrhythmias and practical approaches of pharmacological treatment of supraventricular tachycardias and ventricular tachycardias is also given in this article.

Keywords:
bradyarrhythmia – tachyarrhythmia – diagnostics – electrophysiology – radiofrequency ablation – pharmacotherapy

news


Sources

1. Di­Marco JP, Philbrick JT. Use of ambu­la­to­ry electro­cardiogra­fic (Holter) mo­ni­to­ring. Ann Intern Med 1990; 113: 53–68.

2. So­vo­vá E, Doupal V, Lukl J. Srov­ná­ní po­uži­tí dvou pří­stro­jů pro dlou­ho­do­bou mo­ni­to­ra­ci EKG při vy­šet­řo­vá­ní srdeč­ních arytmií. Vnitř Lék 2001; 47(10): 670–673.

3. Gre­go­ra­tos G, Cheitlin MD, Connil A et al. ACC/AHA guide­li­nes for implanta­tion of cardiac pa­ce­ma­kers and antiarrhythmia de­vi­ces: a re­port of the ACC/AHA Task Force on Practi­ce Guide­li­nes (Committee on Pa­ce­ma­kers Implanta­tion). J Am Coll Cardiol 1998; 31: 1175–206.

4. Zá­sa­dy pro implanta­ci kardiosti­mu­lá­to­rů a implanta­bilních kardio­vertrů – de­fibri­lá­to­rů. Cor Va­sa 1997; 39(2; Suppl K): 35–42.

5. Zi­pes DP, Di­Marco JP, Gillettte P et al. Guide­li­nes for cli­ni­cal intra­cardiac electrophy­sio­lo­gic stu­dies and cathe­ter abla­tion pro­ce­du­res. AHA/ACC Task Force re­port. Circu­la­tion 1995; 92: 673–91.

6. Moss AJ, Hall WJ, Cannon DS et al. Impro­ved survi­val with an implanted de­fibrilla­tor in pa­tients with co­ro­na­ry di­sea­se at high risk for ventri­cu­lar arrhythmias. N Engl J Med 1996; 335(26): 1933–1940.

7. Buxton AE, Lee KL, Fisher JD et al. A rando­mi­zed stu­dy of the pre­vention of sudden death in pa­tients with co­ro­na­ry arte­ry di­sea­se. Multi­center Unsustai­ned Ta­chy­cardia Trial Investi­ga­tors. N Engl J Med 1999; 341(25): 1882–1890.

8. Kautzner J. Léč­ba a pre­ven­ce náh­lé sr­deč­ní smr­ti – reál­ný cíl? JA­MA–CS 1999; 7: 820–821.

9. Heinc P. Ro­le ka­tetro­vé abla­ce u supra­ventri­ku­lárních ta­chya­rytmií. In: Lukl V, Heinc P et al. Mo­der­ní léč­ba arytmií. Pra­ha: Gra­da 2001: 119–135.

10. Hindricks G. The Multi­center Euro­pean Ra­diofre­guency Survey (MERFS): compli­ca­tons of ra­diofre­quency abla­tion of arrhythmias. Eur Heart J 1993; 14: 1644–1653.

11. Calkins H, Yong P, Miller JM et al. Cathe­ter abla­tion of accesso­ry pathways, atrio­ventri­cu­lar no­dal reentry ta­chy­cardia, and the atrio­ventri­cu­lar junction: fi­nal re­sults of a prospecti­ve, multi­center cli­ni­cal trial. Circu­la­tion 1999; 99(2): 262–270.

12. Ca­patto R, Kuck KH. Cathe­ter abla­tion in the year 2000. Curr Opin Cardiol 2000; 15: 29–40.

13. Mo­ra­dy F. Ra­dio–fre­quency abla­tion as treatment for cardiac arrhythmias. N Engl J Med 1999; 340: 534–544.

14. An­der­son J. Acu­te treatment of atrial fibrilla­tion and flutter. J Am Coll Cardiol 1996; 17: 17–21.

15. Waldo A, Prystowsky EN. Drug treatment of atrial fibrilla­tion in the ma­na­ged era. Am J Cardiol 1998, 81(5; Suppl C): 23–29.

16. Podrid PJ. Amio­da­ro­ne: Reeva­lua­tion of an old drug. Ann Int Med 1995; 122(9): 689–700.

17. The Si­ci­lian Gam­bit. A new approach to the classi­fi­ca­tion of antiarrhythmic drugs ba­sed on their actions on arrhythmo­ge­nic me­cha­nisms. Eur Heart J 1991; 12(10): 1112–1131.

18. Hondeghem LM, Sny­ders DJ. Class III antiarrhythmic agents ha­ve a lot of po­tential but a long way to go. Circu­la­tion 1990; 81: 686–690.

19. Antze­le­vith C, Si­cou­ri S. Cli­ni­cal re­le­van­ce of cardiac arrhythmias ge­ne­ra­ted by afterde­po­la­ri­za­tions. J Am Coll Cardiol 1994; 23(1): 259–277.

20. Jurkie­wicz NK, Sangui­netti MC. Ra­te–de­pendent pro­longa­tion of cardiac ac­ti­on po­tentials by a metha­ne­sulfo­na­ni­li­de class III antiarrhythmic agent: Spe­ci­fic block of ra­pidly acti­va­ting de­layed recti­fier K current by do­fe­ti­li­de. Circ Res 1993; 72(1): 75–83.

21. Wang Z, Fermi­ni B, Nattel S. De­layed recti­fier outward current and re­po­la­ri­za­tion in hu­man atrial myocy­tes. Circ Res 1993; 73(2): 276–285.

22. Woosley RL, Hardey JT, Wang T et al. Concentra­tion response re­la­tions for the multiple antiarrhythmic actions of so­ta­lol. Am J Cardiol 1990; 65(2; Suppl A): 22–27.

23. Anasta­siou–Na­na MI, Gilbert EM, Miller RH et al. Use­fulness of DL so­ta­lol for suppression of chro­nic ventri­cu­lar arrhythmias. Am J Cardiol 1991; 67: 511–516.

24. Thu­ma­la A, Harnmermeister KE, Campbell WB et al. He­mo­dy­na­mic stu­dies with so­ta­lol in men performed at rest, du­ring exerci­se and du­ring right ventri­cu­lar pa­cing. Am Heart J 1971; 82(4): 439–447.

25. Lloyd EA, Char­les RG, Gordon–GD et al. Be­ta–blocka­de by so­ta­lol in early myocardial infarction decrea­ses ventri­cu­lar arrhythmias without increa­sing left ventri­cu­lar vo­lu­me. S Afr Med J 1988; 74(1): 5–10.

26. Winters SL, Ku­kin M, Pe E et al. Effect of oral so­ta­lol on syste­mic he­mo­dy­na­mics and programmed electri­cal sti­mu­la­tion in pa­tients with ventri­cu­lar arrhythmias and structu­ral heart di­sea­se. Am J Cardiol 1993; 72(4; Suppl A): 38–43.

27. Sung RJ, Tan HL, Ka­ra­gou­nis L et a1. Intra­ve­nous so­ta­lol for the termi­na­tion of supra­ventri­cu­lar ta­chy­cardia and atrial fibrilla­tion and flutter. A multi­center, rando­mi­zed, double–blind, pla­ce­bo controlled stu­dy. So­ta­lol Multi­center Studv Group. Am Heart J 1995; 129(4): 739–748.

28. Vos MA, Go­litsin SR, Stangl K et al. Su­pe­rio­ri­ty of ibu­ti­li­de (a new class III agent) over DL–so­ta­lol in converting atrial flutter and fibrilla­tion. Heart 1998; 79(6): 568–573.

29. Poelzl G, Kratzer H, Ebner A et al. Prospecti­ve compa­ri­son of fle­cai­ni­de ver­sus so­ta­lol for imme­dia­te cardio­version of atrial fibrilla­tion. Am J Cardiol 1998; 81(12): 1450–1454.

30. Benditt DG, Williams JH, Jin J et al. Mainte­nance of si­nus rhythm with oral DL so­ta­lol the­ra­py in pa­tients with sympto­ma­tic atrial fibrilla­tion and/or atrial flutter. Am J Cardiol 1999; 84: 270–277.

31. Reimold SC, Cantillon CO, Friedman PL et al. Pro­pa­fe­no­ne ver­sus so­ta­lol for suppression of re­current sympto­ma­tic atrial fibrilla­tion. Am J Cardiol 1993; 71(7): 558–563.

32. Lee SH, Chen S.A, Tai DT et al. Compa­ri­son of oral pro­pa­fe­no­ne and so­ta­lol as an ini­tial treatment in pa­tients with sympto­ma­tic pa­ro­xysmal atrial fibrilla­tion. Am J Cardiol 1997; 79: 905–908.

33. Ca­runchio A, Fe­ra MS, Mazza A et al. A compa­ri­son between fle­cai­ni­de and so­ta­lol in the pre­vention of re­currences of pa­ro­xysmal atrial fibrilla­tion. G Ital Cardiol 1995; 25(1): 51–68.

34. Roy D, Ta­la­jic M, Do­ri­an P et al. Amio­da­ro­ne to pre­vent re­currence of atrial fibrilla­tion. N Engl J Med 2000; 343(13): 913–920.

35. Rasmussen HS. Do­fe­ti­li­de, a no­vel class 3 antiarrhythmic agent. J Cardio­vasc Pharma­col 1992; 20: 96–104.

36. Tham TCK, Mac Lennan BA, Burke M et al. Pharma­co­dy­na­mics and pharma­co­ki­ne­tics of the class III antiarrhythmic agent do­fe­ti­li­de in hu­mans. J Cardio­vasc Pharma­col 1993; 21: 507–512.

37. De­mo­lis GM, Funck–Brenta­no C, Ro­pers JR et al. Influence of do­fe­ti­li­de on QT in­ter­val du­ra­tion and dispersion at va­rious heart ra­tes du­ring exerci­se in hu­mans. Circu­la­tion 1996; 94(7): 1592–1599.

38. Ko­wey PR, Ma­rinchack RA, Rials SJ et al. Pharma­co­lo­gic and pharma­co­ki­ne­tic pro­fi­le of the class 3 antiarrhythmic drugs. Am J Cardiol 1997; 80(Suppl G): 16–23.

39. Na­de­ma­nee K, Bailey WM, O'Neill G et al. Electrophy­sio­lo­gic and he­mo­dy­na­mic effects of do­fe­ti­li­de in pa­tients with depressed ventri­cu­lar function: A rando­mi­zed, double–blind, pla­ce­bo–controlled stu­dy. PA­CE 1998; 21: 867.

40. Singh SN, Zab1 RG, Yellen LG et al. Effi­ca­cy and sa­fe­ty of oral do­fe­ti­li­de in converting to and maintai­ning si­nus rhythm in pa­tients with chro­nic atrial fibrilla­tion or atrial flutter. The sympto­ma­tic atrial fibrilla­tion investi­ga­ti­ve re­search on do­fe­ti­li­de (SA­FI­RE–D) stu­dy. Circu­la­tion 2000; 102: 2385–2390.

41. Campbell T, Greenbaum RA, Channer KS et al. Morta­li­ty in pa­tients with atrial fibrilla­tion –1 year follow up of EME­RALD (Euro­pean and Austra­lian Multi­center Eva­lua­tion Re­search of Atrial Fibrilla­tion Do­fe­ti­li­de). J Am Coll Cardiol 2000; 35(Suppl A): 154.

42. Norgaard BL, Watchell K, Christensen PD et al. Effi­ca­cy and sa­fe­ty of intra­ve­nously admi­niste­red do­fe­ti­li­de in acu­te termi­na­tion of atrial fibrilla­tion and flutter: A multi­center, rando­mi­zed, double–blind, pla­ce­bo–controlled trial. Am Heart J 1999; 137(6): 1062–1069.

43. Pe­dersen OD, Bagger H, Keller N et al. Effi­ca­cy of do­fe­ti­li­de in the treatment of atrial fibrilla­tion–flutter in pa­tients with re­du­ced left ventri­cu­lar functions. A Da­nish Investi­ga­tions of Arrhythmia and Morta­li­ty ON Do­fe­ti­li­de (DIAMOND) substu­dy. Circu­la­tion 2001; 104(3): 292–295.

44. Pratt CM, Ruskin JN, Friedrieck T. Do­fe­ti­li­de use in atrial fibrilla­tion: A treatment stra­te­gy to mi­ni­mi­ze proarrhythmic risk. (Abstract). J Am Coll Cardiol 2000; 35(Suppl A): 154.

45. Lee KS. Ibu­ti­li­de, a new compound with po­tent class 3 antiarrhythmic acti­vi­ty, acti­va­tes a slow inward Na+ current in guinea pig ventri­cu­lar cells. J Pharma­col Exp Ther 1998; 262(1): 99–108.

46. Yang T, Sny­ders DJ, Ro­den DM. Ibu­ti­li­de, a metha­ne­sulfo­na­ni­li­de antiarrhythmic, is a po­tent blocker of the ra­pidly–acti­va­ting de­layed recti­fier K current (I,U) in AT–1 cells. Circu­la­tion 1995; 91: 216–221.

47. Murray KT. Ibu­ti­li­de. Circu­la­tion 1998; 97: 493–497.

48. Volgman AS, Carberry PA, Stambler BS. Conversion effi­ca­cy and sa­fe­ty of intra­ve­nous ibu­ti­li­de compa­red with intra­ve­nous pro­cai­na­mi­de in pa­tients with atrial flutter or fibrilla­tion. J Am Coll Cardiol 1998; 31: 1414–1419.

49. Tai ChT, Chen SA, Feng AN et al. Electropharma­co­lo­gic effect of class I and class III antiarrhythmia drugs on ty­pi­cal atrial flutter. Circu­la­tion 1998; 97: 1935–1945.

50. Oral K, Souza JJ, Mi­chaud GF et al. Fa­ci­li­ta­ting transtho­ra­cic cardio­version of atrial fibrilla­tion with ibu­ti­li­de pretreatment. N Engl J Med 1999; 340(24): 1849–1854.

51. Ko­wey PR, VanderLugt JR, Lu­de­rer JR. Sa­fe­ty and risk/be­ne­fit ana­ly­sis of ibu­ti­li­de for acu­te cardio­version of atrial fibrilla­tion/flutter. Am J Cardiol 1996; 78(8; Suppl A): 46–52.

52. Pritchett E, Pa­ge R. Conno­ly S et al. Antiarrhythmic effects of azi­mi­li­de in atrial fibrilla­tion: Effi­ca­cy and do­se–response. Azi­mi­li­de Supra­ventri­cu­lar Arrhythmia Pro­gram (SVA–)3 Investi­ga­tors. J Am Coll Cardiol 2000; 36(3): 794–802.

53. Camm AJ, Pratt CM, Schwartz PJ et al. Morta­li­ty in pa­tients after a re­cent myocardial infarction. A rando­mi­zed, pla­ce­bo–controlled trial of azi­mi­li­de using heart ra­te va­ria­bi­li­ty for risk stra­ti­fi­ca­tion. Circu­la­tion 2004; 109(8): 990–996.

54. Manning AS, Bruy­ninckx C, Ramboux J et al. SR 33589, a new amio­da­ro­ne–li­ke agent: Effect on ische­mia and re­perfu­sion–indu­ced arrhythmias in anesthe­si­zed rats. J Cardio­vasc Pharma­col 1995; 26: 453–461.

55. Sun W, Sarma JSM, Singh BN. Electrophy­sio­lo­gi­cal effects of dro­ne­da­ro­ne (SR33589), a non–iodi­na­ted benzo­fu­ran de­ri­va­ti­ve, in the rabbit heart. Circu­la­tion 1999; 100: 2276–2281. do­pl­nit sva­zek

56. Verdvin SC, Vos MA, Leunissen HDM et al. Eva­lua­tion of the acu­te electrophy­sio­lo­gic effect of intra­ve­nous dro­ne­da­ro­ne, an amio­da­ron–li­ke agent, with spe­cial empha­sis on ventri­cu­lar re­po­la­ri­za­tion and acqui­red torsa­de de pointes arrhythmias. J. Cardio­vasc Pharma­col 1999; 33: 212–222.

57. Wang Z, Fermi­ni B, Nattel S. Sustai­ned de­po­la­ri­za­tion–indu­ced outward current in hu­man atrial myocy­tes: Evi­den­ce for a no­vel de­layed recti­fier K current in hu­man ventricle. Circ Res 1993; 73: 1061–1076.

58. Sa­to R, Hi­sa­to­me I, Wasserstro­me JA. Ace­tylcho­li­ne sensi­ti­ve po­tassium channels in hu­man atrial myocy­tes. Am J Phy­siol 1990; 259(6; Suppl H):1730–1735.

59. Farshi R, Kistner D, Sarma JS et al. Ventri­cu­lar ra­te control in chro­nic atrial fibrilla­tion du­ring daily acti­vi­ty and programmed exerci­se. J Am Coll Cardiol 1999; 33(2): 304–310.

60. Le­wis R, Lakha­mi M, Mo­re­land TA et al. A compa­ri­son of ve­ra­pa­mil and di­go­xin in the treatment of atrial fibrilla­tion. Eur Heart J 1987; 8(2): 148–51.

61. Rawles JM. What is meant by a „controlled“ ventri­cu­lar ra­te in atrial fibrilla­tion? Br Heart J 1990; 63: 157–61.

62. Go­mes JA, Ha­ri­man RI, Kang PS et al. Sustai­ned sympto­ma­tic si­nus no­de reentrant ta­chy­cardia: Inci­dence, cli­ni­cal signi­fi­cance, electrophy­sio­lo­gic observa­tions and the effects of anti–arrhythmic agents. J Am Coll Cardiol 1985; 5: 545–557.

63. The Cardiac Arrhythmia Supression Trial (CAST) investi­ga­tors. Pre­li­mi­na­ry re­port: Effect of encai­ni­de anf fle­cai­ni­de on morta­li­ty in rando­mi­zed trial of arrhythmia supression after myocardial infarction. N Engl J Med 1989; 3321: 406–412.

64. Waldo AL, Camm AJ, de­Ruy­ter H et al. Effect of d–so­ta­lol on morta­li­ty in pa­tients with left ventri­cu­lar dysfunction after re­cent and re­mo­te myocardial infarction. Lancet 1996; 348: 7–11.

65. Fla­ker GC, Blackshear JL, McBri­de R et al. Antiarrhythmic drug the­ra­py and cardiac morta­li­ty in atrial fibrilla­tion. J Am Coll Cardiol 1992; 20: 527–532.

66. Middle­kauff HR, Ste­ven­son WG, Sa­xon LA et al. Amio­da­ro­ne and torsa­des de pointes in pa­tients with advanced heart failu­re. Am J Cardiol 1995; 76(7): 499–502.

67. MacNeil DJ. The si­de effect pro­fi­le of class III antiarrhythmic drugs; fo­cus on d, l–so­ta­lol. Am J Cardiol 1997; 80(Suppl G): 90–8.

68. Pre­dictors of thromboembo­lism in atrial fibrilla­tion: II. Echo­cardiographic featu­res of pa­tients at risk. The Stro­ke Pre­vention in Atrial Fibrilla­tion Investi­ga­tors. Ann Intern Med 1992; 116(1): 6–12.

69. Kjekshus J. Arrhythmias and morta­li­ty in congesti­ve heart failu­re. Am J Cardiol 1990; 65(Suppl I): 42–48.

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