Circulation, Vol 81, 686-690, Copyright © 1990 by American Heart Association
LM Hondeghem and DJ Snyders
With regard to currently available class III agents, although their class
III effect may reduce the likelihood of tachycardia initiation, their
reverse use-dependent prolongation of action potential duration reduces
their effectiveness during tachycardias and may even render them
proarrhythmic, especially after long diastolic intervals. In contrast,
agents that exhibit normal use-dependent prolongation of refractoriness
hold great promise: While having relatively less effects on the normal
heart beat, they could induce self-termination of a tachycardia.
Prolongation of refractoriness can be achieved by lengthening of action
potential duration and delaying recovery of excitability. Combination of
these drug actions may yield important clinical applications.
ARTICLES
Class III antiarrhythmic agents have a lot of potential but a long way to go. Reduced effectiveness and dangers of reverse use dependence
Department of Medicine, Vanderbilt University, Nashville, Tennessee 37232.
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A. van de Loo, T. Klingenheben, and S. H. Hohnloser Amiodarone Therapy After Previous Sotalol-induced Torsade de Pointes: Analysis of QT Dispersion to Predict Proarrhythmia Journal of Cardiovascular Pharmacology and Therapeutics, January 1, 1996; 1(1): 75 - 78. [Abstract] [PDF]
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G. A. Gintant Two Components of Delayed Rectifier Current in Canine Atrium and Ventricle : Does IKs Play a Role in the Reverse Rate Dependence of ClassIII Agents? Circ. Res., January 1, 1996; 78(1): 26 - 37. [Abstract] [Full Text]
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M. W. Veldkamp, A. C.G. van Ginneken, T. Opthof, and L. N. Bouman Delayed Rectifier Channels in Human Ventricular Myocytes Circulation, December 15, 1995; 92(12): 3497 - 3504. [Abstract] [Full Text]
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M. A. Vos, S. C. Verduyn, A. P.M. Gorgels, G. C. Lipcsei, and H. J.J. Wellens Reproducible Induction of Early Afterdepolarizations and Torsade de Pointes Arrhythmias by d-Sotalol and Pacing in Dogs With Chronic Atrioventricular Block Circulation, February 1, 1995; 91(3): 864 - 872. [Abstract] [Full Text]
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J. J. Salata, N. K. Jurkiewicz, A. A. Wallace, R. F. Stupienski III, P. J. Guinosso Jr, and J. J. Lynch Jr Cardiac Electrophysiological Actions of the Histamine H1-Receptor Antagonists Astemizole and Terfenadine Compared With Chlorpheniramine and Pyrilamine Circ. Res., January 1, 1995; 76(1): 110 - 119. [Abstract] [Full Text]
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S. H. Hohnloser and R. L. Woosley Sotalol N. Engl. J. Med., July 7, 1994; 331(1): 31 - 38. [Full Text]
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