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[Serial testing of antiarrhythmic agents using programmed stimulation in recurrent ventricular tachycardia]
Vnitrni Lekarstvi
|March 1, 1992
Summary
Serial drug testing using programmed electrical stimulation effectively identified antiarrhythmic drugs for ventricular tachycardia. While generally successful, severe side effects in some cases suggest considering defibrillator implantation for combined therapy.
Area of Science:
- Clinical Electrophysiology
- Pharmacology
- Cardiology
Context:
- Relapsing monomorphic persistent ventricular tachycardia (S-KT) poses significant therapeutic challenges.
- Current antiarrhythmic drug selection may lead to underestimation of efficacy.
- Programmed electrical stimulation (PES) offers a method for in vivo drug testing.
Purpose:
- To evaluate the effectiveness of serial drug testing (STL) via PES in managing S-KT.
- To assess short-term and long-term efficacy of antiarrhythmic therapies selected by STL.
- To compare STL-guided therapy with alternative treatments like defibrillator implantation.
Summary:
- Serial drug testing (STL) using programmed electrical stimulation (PES) was performed on 41 patients with S-KT.
- STL successfully identified effective antiarrhythmic drugs in 85% of patients, preventing S-KT induction.
- Long-term follow-up showed sustained efficacy, with recurrence rates increasing over time; however, serious side effects were noted in some cases.
Impact:
- STL guided by PES provides a rational approach to pharmacotherapy for serious ventricular arrhythmias.
- The study highlights the need for careful consideration of side effects, particularly with combined amiodarone and Class I antiarrhythmic therapy.
- Implantation of a defibrillator may be a preferable alternative to combined drug therapy due to its high incidence of serious adverse effects.