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Effects of antiarrhythmic agents on left ventricular function during exercise in patients with chronic left
Yasuo Takada1, Satoshi Isobe, Mitsuhiro Okada
1Division of Cardiology, Nagoya National Hospital, Japan.
Annals of Nuclear Medicine
|July 6, 2004
Summary
Disopyramide and pilsicainide reduce exercise systolic function in patients with chronic left ventricular (LV) dysfunction. Mexiletine did not significantly alter these parameters, suggesting careful consideration for disopyramide and pilsicainide use.
Area of Science:
- Cardiology
- Pharmacology
- Cardiac Electrophysiology
Background:
- Chronic left ventricular (LV) dysfunction is often associated with ventricular arrhythmias.
- Antiarrhythmic agents are used to manage arrhythmias, but their impact on cardiac function, especially during exercise, requires careful evaluation.
- Assessing the effects of these drugs on global LV function during physiological stress is crucial for patient management.
Purpose of the Study:
- To investigate the effects of disopyramide, mexiletine, and pilsicainide on global left ventricular (LV) function during exercise in patients with chronic LV dysfunction.
- To compare the impact of these antiarrhythmic agents on exercise-induced changes in LV ejection fraction (LVEF) and peak ejection rate (PER).
Main Methods:
- Thirty-five patients with LV dysfunction (LVEF < 45%) and ventricular arrhythmias were enrolled.
- Patients were randomized to receive a single oral dose of disopyramide, mexiletine, or pilsicainide.
- Equilibrium-gated cardiac-pool scintigraphy was performed at rest and peak exercise before and after drug administration to assess LVEF and PER.
Main Results:
- Disopyramide and pilsicainide significantly reduced exercise LVEF and PER compared to baseline and the mexiletine group.
- The changes in LVEF and PER from rest to peak exercise were significantly blunted after disopyramide and pilsicainide administration.
- Mexiletine did not cause significant changes in these functional parameters during exercise.
Conclusions:
- Disopyramide and pilsicainide can impair systolic LV function during exercise in patients with chronic LV dysfunction.
- Caution is advised when prescribing disopyramide and pilsicainide to this patient population due to potential negative effects on cardiac performance.
- Mexiletine appears to be a safer alternative regarding exercise-induced LV function in patients with LV dysfunction and arrhythmias.