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Long-term antiarrhythmic therapy with cibenzoline
S M Mohiuddin1, D E Hilleman, D Esterbrooks
1Drug Evaluation Unit, Creighton University School of Medicine, Omaha, NE 68131.
Insights
Cibenzoline effectively treats chronic ventricular arrhythmias in the short term for most patients. Long-term efficacy requires periodic assessment, as some patients may lose arrhythmia control or experience adverse effects.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Chronic ventricular arrhythmias pose a significant clinical challenge.
- Effective and safe antiarrhythmic therapies are crucial for patient management.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of cibenzoline in patients with chronic ventricular arrhythmias.
- To assess the impact of cibenzoline on left ventricular function.
Main Methods:
- Single-blind, placebo-controlled study involving 19 patients.
- Dose titration followed by long-term therapy assessment.
- Echocardiographic evaluation of left ventricular function.
Main Results:
- Short-term efficacy achieved in 74% of patients, with significant reductions in premature ventricular complexes (PVCs) and ventricular tachycardia (VT).
- Long-term efficacy was maintained in 36% of initial responders.
- Adverse effects occurred in 37% of patients, with only one discontinuation due to side effects.
- No deleterious effect on overall left ventricular function; improvement noted in patients with pre-existing dysfunction.
Conclusions:
- Cibenzoline is effective for short-term management of chronic ventricular arrhythmias.
- Long-term use necessitates ongoing monitoring for sustained efficacy and potential adverse events.
- Cibenzoline appears safe for patients with compensated left ventricular dysfunction.
Abstract:
This single-blind, placebo-controlled study evaluated long-term therapy with cibenzoline in 19 patients with chronic ventricular arrhythmias. Antiarrhythmic efficacy, defined as greater than or equal to 75% reduction in single premature ventricular complexes (PVCs), greater than or equal to 90% reduction in paired PVCs, and total abolition of ventricular tachycardia (VT), was established after dose titration in 14 of 19 (74%) patients. Mean frequency of single PVCs was reduced by 65%, mean paired PVC frequency was reduced by 68%, and mean VT event frequency was reduced by 82%. Antiarrhythmic efficacy was maintained during long-term therapy in five of the 14 (36%) short-term responders. Of the nine patients who discontinued cibenzoline during long-term follow-up, five had a loss of arrhythmia control, three failed to redevelop arrhythmias during placebo reintroduction, and one developed an adverse reaction. Three patients (16%) experienced a proarrhythmic effect. Echocardiographic evaluation did not reveal any deleterious effect of cibenzoline on left ventricular function in the group as a whole. In six patients with preexisting left ventricular dysfunction, left ventricular ejection fraction and fractional shortening improved significantly (P less than .05) during cibenzoline therapy. Adverse effects occurred in seven patients (37%) but necessitated drug discontinuation in only one patient (5%). Cibenzoline provides effective short-term therapy for patients with chronic ventricular arrhythmias. Long-term therapy must be assessed periodically to ensure continued efficacy. Drug-related adverse effects occur infrequently. Cibenzoline can be used safely in patients with compensated left ventricular dysfunction.