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Interactions between drugs and devices: experimental and clinical studies
1Department of Cardiology, University of Bonn, Germany.
American Heart Journal
|April 1, 1994
Summary
Antiarrhythmic drugs can affect implantable cardioverter-defibrillator (ICD) function. Amiodarone significantly increased the defibrillation threshold (DFT), while mexiletine did not, highlighting the importance of reassessing DFT when initiating antiarrhythmic therapy.
Area of Science:
- Cardiology
- Electrophysiology
- Pharmacology
Background:
- Antiarrhythmic therapy is often used alongside implantable cardioverter-defibrillators (ICDs).
- Understanding drug interactions with ICDs is crucial for patient safety.
- A significant percentage of patients with ICDs receive antiarrhythmic medications for various arrhythmias.
Purpose of the Study:
- To investigate the impact of antiarrhythmic agents on the defibrillation threshold (DFT) in patients with ICDs.
- To determine if specific antiarrhythmic drugs alter the energy required for defibrillation.
Main Methods:
- A cohort of 101 patients with ICDs was studied.
- Review of antiarrhythmic drug use and its indications.
- Prospective assessment of DFT changes in patients receiving amiodarone and mexiletine.
Main Results:
- Amiodarone (400 mg/day) significantly increased DFT (14.1 to 20.9 J, p < 0.001).
- Mexiletine (720 mg/day) did not significantly affect DFT.
- Animal studies showed variable effects of other antiarrhythmics on DFT.
Conclusions:
- The effect of antiarrhythmic drugs on DFT must be considered in patients with ICDs.
- Defibrillation threshold and safety margin should be assessed before and after initiating antiarrhythmic therapy.
- Reassessment of DFT is recommended if the initial safety margin is small upon starting antiarrhythmic drugs.