Quinidine for ventricular arrhythmias: A comprehensive review
Redwane Rakza1, Pierre Groussin1, Karim Benali2
1Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, F-35000 Rennes, France.
Trends in Cardiovascular Medicine
|July 30, 2024
Summary
Quinidine, a foundational antiarrhythmic drug, is regaining importance for treating complex ventricular arrhythmias. This review explores its current indications, supporting evidence, and future directions for safe and accessible use.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Quinidine was a pioneering Class Ia antiarrhythmic drug extensively used in the 20th century.
- Declining use in the 1990s was due to safety concerns and newer alternatives.
- Recent research highlights quinidine's efficacy in specific, often refractory, ventricular arrhythmias.
Purpose of the Study:
- To comprehensively review current European and American recommendations for quinidine use.
- To explore evidence-based indications for quinidine, particularly in challenging arrhythmias.
- To discuss future research needs, safety mitigation, and accessibility of quinidine.
Main Methods:
- Literature review of European and American clinical guidelines.
- Analysis of studies supporting quinidine's use in various cardiac conditions.
- Discussion of pharmacokinetic and pleiotropic effects of Class Ia antiarrhythmics.
Main Results:
- Quinidine remains valuable for Brugada syndrome, idiopathic ventricular fibrillation, early repolarization syndrome, short QT syndrome, and electrical storms.
- Evidence supports its role where other antiarrhythmic drugs have failed.
- The review synthesizes current knowledge on quinidine's therapeutic applications.
Conclusions:
- Quinidine is a critical therapeutic option for specific, severe ventricular arrhythmias.
- Further research is needed to optimize patient selection and minimize iatrogenic risks.
- Ensuring equitable access to quinidine is essential for patient care.
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