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Electrophysiologic response to moricizine in patients with sustained ventricular arrhythmias
A C Powell1, M R Gold, R Brooks
1Massachusetts General Hospital, Boston.
Objective:
To assess the short-term efficacy and safety of moricizine in patients receiving electrophysiologically guided therapy for sustained ventricular arrhythmias refractory to treatment with class IA antiarrhythmic agents.
Design:
Uncontrolled clinical trial.
Setting:
Referral-based teaching medical center.
Patients:
Twenty-one patients (18 of whom had coronary artery disease) with a mean left ventricular ejection fraction of 32% +/- 11% who presented with sustained ventricular tachycardia (13 patients), syncope (4 patients), or cardiac arrest (4 patients).
Interventions:
Moricizine, 743 +/- 85 mg daily.
Measurements:
Electrophysiologic testing in the drug-free state and after administration of moricizine unless sustained arrhythmias occurred.
Main Results:
Sustained ventricular tachycardia was inducible in the absence of antiarrhythmic drugs in 20 patients and was not suppressed by moricizine in any patient. Four patients had six episodes of spontaneous ventricular tachycardia while receiving moricizine. A probable proarrhythmic response occurred in four patients.
Conclusion:
In patients with compromised left ventricular function caused by coronary artery disease in whom class IA antiarrhythmics were ineffective, moricizine was ineffective in suppressing sustained ventricular arrhythmias and resulted in proarrhythmic effects in some patients.
Insights
Moricizine did not suppress sustained ventricular arrhythmias in patients with coronary artery disease and poor left ventricular function. The drug also showed proarrhythmic effects in some individuals, indicating limited efficacy and potential risks.
Area of Science:
- Cardiology
- Clinical Electrophysiology
- Pharmacology
Background:
- Sustained ventricular arrhythmias pose a significant risk, particularly in patients with compromised left ventricular function.
- Class IA antiarrhythmic agents are often a first-line treatment for these conditions.
- Moricizine is an antiarrhythmic drug evaluated for patients refractory to other treatments.
Observation:
- This study assessed moricizine's efficacy and safety in 21 patients with sustained ventricular arrhythmias unresponsive to class IA agents.
- Patients had a mean left ventricular ejection fraction of 32% and significant coronary artery disease.
- Electrophysiologic testing was used to guide therapy and assess drug response.
Findings:
- Moricizine failed to suppress inducible sustained ventricular tachycardia in all 20 patients tested.
- Four patients experienced spontaneous ventricular tachycardia episodes while on moricizine.
- A probable proarrhythmic response was observed in four patients.
Implications:
- Moricizine appears ineffective for suppressing sustained ventricular arrhythmias in this patient population.
- The drug demonstrated potential proarrhythmic effects, raising safety concerns.
- Alternative therapeutic strategies are needed for patients with refractory ventricular arrhythmias and impaired left ventricular function.
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