Related Experiment Videos
[Effect of barucainide on left ventricular ejection fraction in patients with ventricular cardiac arrhythmias]
M Scheininger1, J Dziersk, W Kullak
1Klinikum Innenstadt, Ludwig-Maximilians-Universität München.
Insights
Barucainide, an investigational antiarrhythmic drug, effectively reduced ventricular arrhythmias in most patients with complex arrhythmias and depressed heart function. The drug was generally well-tolerated, though it caused a significant rise in serum creatinine levels.
Area of Science:
- Cardiology
- Pharmacology
- Electrophysiology
Background:
- Ventricular arrhythmias pose a significant risk, especially in patients with impaired left-ventricular function.
- Class Ib antiarrhythmic drugs are used to manage cardiac arrhythmias.
- Barucainide is an investigational antiarrhythmic agent.
Purpose of the Study:
- To evaluate the efficacy and safety of barucainide in patients with frequent and complex ventricular arrhythmias (Lown grade 4a/4b) and depressed left-ventricular ejection fraction.
- To assess the impact of barucainide on ventricular arrhythmia frequency and left-ventricular ejection fraction.
Main Methods:
- A single-blind, placebo-controlled trial involving 10 patients.
- Patients received either placebo or barucainide (300-400 mg/day).
- Ventricular arrhythmias and left-ventricular ejection fraction were monitored.
Main Results:
- Barucainide significantly reduced ventricular arrhythmias in 7 out of 10 patients.
- One patient experienced a proarrhythmic effect from barucainide.
- Left-ventricular ejection fraction was not significantly altered overall, but decreased by over 5% in one patient.
- A significant increase in serum creatinine was observed in all patients (p < 0.005).
Conclusions:
- Barucainide demonstrates good antiarrhythmic efficacy in patients with frequent ventricular arrhythmias and depressed left-ventricular function.
- The drug is generally well-tolerated in this patient population.
- The observed rise in serum creatinine requires further investigation to elucidate its mechanism.
Abstract:
We studied the effect of barucainide, an investigational class lb antiarrhythmic drug, on ventricular arrhythmias and left-ventricular ejection fraction in 10 patients with frequent and complex ventricular arrhythmias (Lown grade 4a/4b). The study was conducted as a single-blind and placebo-controlled trial. With placebo, mean frequency of ventricular arrhythmias was 6238 VPB/24 h, 510 couplets/24 h, and 24 salvos/24 h. Mean left-ventricular ejection fraction was 37.6%, ranging from 18% to 58%. Therapy with barucainide (300-400 mg/day) resulted in a significant reduction of ventricular arrhythmias in 7 of 10 patients; in one patient barucainide had a clear proarrhythmic effect. Over all, left-ventricular ejection fraction (37.6% +/- 12% with placebo vs 36.1% +/- 11% with barucainide) was not significantly altered. In one patient, however, it was depressed by more than 5%; one patient complained of shortness of breath during exercise. None of the four patients with an initial ejection fraction below 35% showed a drop of ejection fraction during therapy with barucainide. The only main adverse effect was a small, but significant (p less than 0.005) rise of serum-kreatinine (1.13 +/- 0.26 vs 1.39 +/- 0.38 mg%) in all patients. We conclude that barucainide has a good antiarrhythmic effect and is usually well tolerated in patients with markedly depressed left-ventricular function. The mechanism causing the rise of serum-kreatinin, however, needs to be clarified in further studies.