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Effect of cibenzoline, a class ia antiarrhythmic agent, on left ventricular diastolic function in hypertrophic

I Kondo1, K Mizushige, S Nozaki

  • 1Second Department of Internal Medicine, Kagawa Medical University, Japan.

Cardiovascular Drugs and Therapy
|February 22, 2002
PubMed

Insights

Cibenzoline improves left ventricular diastolic function in hypertrophic cardiomyopathy (HCM) primarily through a direct lusitropic effect, not by reducing afterload. This finding differentiates its mechanism from other treatments in HCM patients.

Area of Science:

  • Cardiology
  • Pharmacology
  • Echocardiography

Background:

  • Hypertrophic obstructive cardiomyopathy (HOCM) is characterized by impaired left ventricular (LV) diastolic function.
  • The mechanisms underlying diastolic improvement with antiarrhythmic drugs in HOCM require clarification.
  • Cibenzoline, a class Ia antiarrhythmic, has shown potential in improving diastolic function, but its precise mechanism is debated.

Purpose of the Study:

  • To determine if cibenzoline improves LV diastolic function in hypertrophic cardiomyopathy (HCM) via LV afterload reduction or a direct lusitropic effect.
  • To compare the effects of cibenzoline with bisoprolol on LV diastolic function and outflow pressure gradients in HCM patients.

Main Methods:

  • Twenty-three patients with HCM (11 HOCM, 12 non-obstructive HCM [HNCM]) underwent echocardiography before and after oral cibenzoline (300 mg).
  • Measurements included pulsed-wave Doppler, color M-mode, and tissue Doppler to assess diastolic parameters (E, FPV, Ea) and LV filling pressures (E/FPV, E/Ea).
  • LV outflow pressure gradients were measured using continuous-wave Doppler; findings were compared with bisoprolol treatment in HNCM.

Main Results:

  • Cibenzoline significantly reduced LV outflow pressure gradients in HOCM patients.
  • Cibenzoline administration led to significant decreases in E/FPV and E/Ea in both HOCM and HNCM groups, indicating improved LV diastolic function.
  • Bisoprolol did not alter diastolic function indices in the HNCM group.

Conclusions:

  • Cibenzoline demonstrably improves left ventricular diastolic function in patients with hypertrophic cardiomyopathy.
  • The primary mechanism for this improvement appears to be a direct lusitropic effect of cibenzoline on the left ventricle.
  • LV afterload reduction may play a secondary role, as cibenzoline's diastolic benefits were observed independently of significant afterload changes in some measures.

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