USEFULNESS OF THE ELECTROPHYSIOLOGY LABORATORY FOR EVALUATION OF PROARRHYTHMIC DRUG RESPONSE IN CORONARY-ARTERY DISEASE

被引:14
作者
BUXTON, AE [1 ]
ROSENTHAL, ME [1 ]
MARCHLINSKI, FE [1 ]
MILLER, JM [1 ]
FLORES, B [1 ]
JOSEPHSON, ME [1 ]
机构
[1] UNIV PENN,SCH MED,DEPT MED,CARDIOVASC SECT,PHILADELPHIA,PA 19104
关键词
D O I
10.1016/0002-9149(91)90616-S
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Two potential manifestations of proarrhythmic responses to type IA antiarrhythmic agents in the electrophysiology laboratory were evaluated in 122 patients with chronic coronary artery disease and previous myocardial infarction: (1) conversion of uniform nonsustained ventricular tachycardia (VT) into sustained VT after drug administration, and (2) induction of sustained VT by fewer extrastimuli after drug administration. Forty-two patients were evaluated for nonsustained VT. Eighty patients were evaluated for sustained VT: 30 of these had spontaneous sustained VT only while receiving empiric therapy with quinidine or procainamide, whereas the remaining 50 developed spontaneous VT in the absence of antiarrhythmic drugs. All patients underwent programmed stimulation in the baseline state and after procainamide. Four patients had conversion of induced uniform nonsustained VT into the same morphology, but sustained VT after procainamide administration. These responses only occurred in patients evaluated for nonsustained VT. Over 90% of patients presenting with sustained VT had uniform sustained VT induced at the baseline study and after procainamide, regardless of whether the spontaneous arrhythmia occurred only in the presence or absence of anti-arrhythmic drugs. There was no significant difference in the change in mode of induction from baseline to procainamide study, regardless of whether patients had developed spontaneous VT only in the presence or absence of antiarrhythmic drugs. One patient with no inducible VT at the baseline study had inducible uniform sustained VT after procainamide administration, and 1 patient with inducible VT at baseline developed spontaneous sustained uniform VT after procainamide administration. Both patients had developed spontaneous sustained VT only while receiving therapy with type IA agents. It is concluded that potential proarrhythmic effects may be observed in response to procainamide administration in the electrophysiology laboratory, but that this response is unusual in this population of patients with chronic coronary artery disease and ventricular arrhythmias: in 4 of 42 patients (10%) with spontaneous nonsustained VT, and 2 of 80 patients (2.5%) presenting with spontaneous sustained VT. It is premature to consider a decrease in the number of extrastimuli required to induce sustained VT after drug administration as a proarrhythmic drug effect.
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页码:835 / 842
页数:8
相关论文
共 16 条
[1]   PROARRHYTHMIC EFFECTS OF ANTIARRHYTHMIC DRUGS DURING PROGRAMMED VENTRICULAR STIMULATION IN PATIENTS WITHOUT VENTRICULAR-TACHYCARDIA [J].
AU, PK ;
BHANDARI, AK ;
BREAM, R ;
SCHRECK, D ;
SIDDIQI, R ;
RAHIMTOOLA, SH .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1987, 9 (02) :389-397
[2]  
BHANDARI A K, 1986, Canadian Journal of Cardiology, V2, P6
[3]   CLINICAL TYPES OF PROARRHYTHMIC RESPONSE TO ANTIARRHYTHMIC DRUGS [J].
BIGGER, JT ;
SAHAR, DI .
AMERICAN JOURNAL OF CARDIOLOGY, 1987, 59 (11) :E2-E9
[4]  
BUXTON AE, 1986, CIRCULATION, V73, P67
[5]   ROLE OF TRIPLE EXTRASTIMULI DURING ELECTROPHYSIOLOGIC STUDY OF PATIENTS WITH DOCUMENTED SUSTAINED VENTRICULAR TACHYARRHYTHMIAS [J].
BUXTON, AE ;
WAXMAN, HL ;
MARCHLINSKI, FE ;
UNTEREKER, WJ ;
WASPE, LE ;
JOSEPHSON, ME .
CIRCULATION, 1984, 69 (03) :532-540
[6]   THE HUMAN ATRIAL STRENGTH-INTERVAL RELATION - INFLUENCE OF CYCLE LENGTH AND PROCAINAMIDE [J].
BUXTON, AE ;
MARCHLINSKI, FE ;
MILLER, JM ;
MORRISON, DF ;
FRAME, LH ;
JOSEPHSON, ME .
CIRCULATION, 1989, 79 (02) :271-280
[7]   LARGE DOSE PROCAINAMIDE THERAPY FOR VENTRICULAR TACHYARRHYTHMIA [J].
GREENSPAN, AM ;
HOROWITZ, LN ;
SPIELMAN, SR ;
JOSEPHSON, ME .
AMERICAN JOURNAL OF CARDIOLOGY, 1980, 46 (03) :453-462
[8]   PROARRHYTHMIC RESPONSES DURING ELECTROPHYSIOLOGIC TESTING [J].
HOROWITZ, LN ;
GREENSPAN, AM ;
RAE, AP ;
KAY, HR ;
SPIELMAN, SR .
AMERICAN JOURNAL OF CARDIOLOGY, 1987, 59 (11) :E45-E48
[9]   SPONTANEOUS SUSTAINED VENTRICULAR TACHYARRHYTHMIAS DURING TREATMENT WITH TYPE-IA ANTIARRHYTHMIC AGENTS [J].
KUDENCHUK, PJ ;
KRON, J ;
WALANCE, C ;
MCANULTY, JH .
AMERICAN JOURNAL OF CARDIOLOGY, 1990, 65 (07) :446-452
[10]   ADVERSE REACTIONS TO ANTIARRHYTHMIC DRUGS DURING THERAPY FOR VENTRICULAR ARRHYTHMIAS [J].
NYGAARD, TW ;
SELLERS, TD ;
COOK, TS ;
DIMARCO, JP .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1986, 256 (01) :55-57