| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Circulation, Vol 84, 1831-1851, Copyright © 1991 by American Heart Association
The Queen's Gambit is an opening move in chess that provides a variety of
aggressive options to the player electing it. This report represents a
similar gambit (the Sicilian Gambit) on the part of a group of basic and
clinical investigators who met in Taormina, Sicily to consider the
classification of antiarrhythmic drugs. Paramount to their considerations
were 1) dissatisfaction with the options offered by existing classification
systems for inspiring and directing research, development, and therapy, 2)
the disarray in the field of antiarrhythmic drug development and testing in
this post-Cardiac Arrhythmia Suppression Trial (CAST) era, and 3) the
desire to provide an operational framework for consideration of
antiarrhythmic drugs that will both encourage advancement and have the
plasticity to grow as a result of the advances that occur. The multifaceted
approach suggested is, like the title of the article, a gambit. It is an
opening rather than a compendium and is intended to challenge thought and
investigation rather than to resolve issues. The article incorporates
first, a discussion of the shortcomings of the present system for drug
classification; second, a review of the molecular targets on which drugs
act (including channels and receptors); third, a consideration of the
mechanisms responsible for arrhythmias, including the identification of
"vulnerable parameter" that might be most accessible to drug effect; and
finally, clinical considerations with respect to antiarrhythmic drugs.
Information relating to the various levels of information is correlated
across categories (i.e., clinical arrhythmias, cellular mechanisms, and
molecular targets), and a "spread sheet" approach to antiarrhythmic action
is presented that considers each drug as a unit, with similarities to and
dissimilarities from other drugs being highlighted. A complete reference
list for this work would require as many pages as the text itself. For this
reason, referencing is selective and incomplete. It is designed, in fact,
to provide sufficient background information to give the interested reader
a starting frame of reference rather than to recognize the complete body of
literature that is the basis for this article.
ARTICLES
The Sicilian gambit. A new approach to the classification of antiarrhythmic drugs based on their actions on arrhythmogenic mechanisms. Task Force of the Working Group on Arrhythmias of the European Society of Cardiology
This article has been cited by other articles:
 |
|
 |
|
  L. Protas, W. Dun, Z. Jia, J. Lu, A. Bucchi, S. Kumari, M. Chen, I. S. Cohen, M. R. Rosen, E. Entcheva, et al. Expression of skeletal but not cardiac Na+ channel isoform preserves normal conduction in a depolarized cardiac syncytium Cardiovasc Res, February 15, 2009; 81(3): 528 - 535. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. H. Lau, C. Clausen, E. A. Sosunov, I. N. Shlapakova, E. P. Anyukhovsky, P. Danilo Jr, T. S. Rosen, C. Kelly, H. S. Duffy, M. J. Szabolcs, et al. Epicardial Border Zone Overexpression of Skeletal Muscle Sodium Channel SkM1 Normalizes Activation, Preserves Conduction, and Suppresses Ventricular Arrhythmia: An In Silico, In Vivo, In Vitro Study Circulation, January 6, 2009; 119(1): 19 - 27. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 U. Ravens and E. Cerbai Role of potassium currents in cardiac arrhythmias Europace, October 1, 2008; 10(10): 1133 - 1137. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. F. von Gunten, S. Eappen, J. F. Cleary, S. G. Taylor IV, P. Moots, N. Regevik, C. Cleeland, and D. Cella Flecainide for the treatment of chronic neuropathic pain: a Phase II trial Palliative Medicine, December 1, 2007; 21(8): 667 - 672. [Abstract] [PDF]
|
|
|
|
|
|
H. M. Den Ruijter, G. Berecki, T. Opthof, A. O. Verkerk, P. L. Zock, and R. Coronel Pro- and antiarrhythmic properties of a diet rich in fish oil Cardiovasc Res, January 15, 2007; 73(2): 316 - 325. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Developed in Collaboration With the European Heart, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) J. Am. Coll. Cardiol., September 5, 2006; 48(5): 1064 - 1108. [Full Text] [PDF]
|
|
|
|
|
|
Developed in Collaboration With the European Heart, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) J. Am. Coll. Cardiol., September 5, 2006; 48(5): e247 - e346. [Full Text] [PDF]
|
|
|
|
 |
|
 D. P. Zipes, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death--executive summary: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Eur. Heart J., September 1, 2006; 27(17): 2099 - 2140. [Full Text] [PDF]
|
|
|
|
|
|
Writing Committee Members, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society Europace, September 1, 2006; 8(9): 746 - 837. [Full Text] [PDF]
|
|
|
|
 |
|
 M. R. Rosen, A. Bucchi, and R. B. Robinson If modulation: perspectives in clinical medicine Eur. Heart J. Suppl., September 1, 2006; 8(suppl_D): D3 - D8. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Ito, Y. Hayashi, Y. Kawai, M. Iwasaki, K. Takada, T. Kamibayashi, A. Yamatodani, and T. Mashimo Diabetes mellitus reduces the antiarrhythmic effect of ion channel blockers. Anesth. Analg., September 1, 2006; 103(3): 545 - 550. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Christ and U. Ravens Do we need new antiarrhythmic compounds in the era of implantable cardiac devices and percutaneous ablation? Cardiovasc Res, December 1, 2005; 68(3): 341 - 343. [Full Text] [PDF]
|
|
|
|
 |
|
 W. V. R. Vieweg and M. A. Wood Tricyclic Antidepressants, QT Interval Prolongation, and Torsade de Pointes Psychosomatics, October 1, 2004; 45(5): 371 - 377. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. A. Eisner and K. R. Sipido Sodium Calcium Exchange in the Heart: Necessity or Luxury? Circ. Res., September 17, 2004; 95(6): 549 - 551. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Thompson and J. R. Balser Perioperative cardiac arrhythmias Br. J. Anaesth., July 1, 2004; 93(1): 86 - 94. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. R. Rosen The Electrocardiogram 100 Years Later: Electrical Insights Into Molecular Messages Circulation, October 22, 2002; 106(17): 2173 - 2179. [Full Text] [PDF]
|
|
|
|
|
|
F. G. Cosio and E. Delpon New Antiarrhythmic Drugs for Atrial Flutter and Atrial Fibrillation: A Conceptual Breakthrough at Last? Circulation, January 22, 2002; 105(3): 276 - 278. [Full Text] [PDF]
|
|
|
|
 |
|
 S M Cobbe, R W F Campbell, A J Camm, A W Nathan, E Rowland, P E Bloch-Thomsen, M Moller, and L Jordaens Effects of intravenous dofetilide on induction of atrioventricular re-entrant tachycardia Heart, November 1, 2001; 86(5): 522 - 526. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Schulze-Bahr, W. Haverkamp, L. Eckardt, P. Kirchhof, H. Wedekind, and G. Breithardt Genetic aspects in acquired long QT syndrome -- a piece in the puzzle Eur. Heart J. Suppl., September 1, 2001; 3(suppl_K): K48 - K52. [Abstract] [PDF]
|
|
|
|
|
|
S.G. Priori, E. Aliot, C. Blomstrom-Lundqvist, L. Bossaert, G. Breithardt, P. Brugada, A.J. Camm, R. Cappato, S.M. Cobbe, C. Di Mario, et al. Task Force on Sudden Cardiac Death of the European Society of Cardiology Eur. Heart J., August 2, 2001; 22(16): 1374 - 1450. [PDF]
|
|
|
|
 |
|
 J. COOKSON Use of antipsychotic drugs and lithium in mania The British Journal of Psychiatry, June 1, 2001; 178 (41): s148 - s156. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J Myerburg and P. M Spooner Opportunities for sudden death prevention: Directions for new clinical and basic research Cardiovasc Res, May 1, 2001; 50(2): 177 - 185. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C Pandozi and M Santini Update on atrial remodelling owing to rate. Does atrial fibrillation always 'beget' atrial fibrillation? Eur. Heart J., April 1, 2001; 22(7): 541 - 553. [PDF]
|
|
|
|
 |
|
 T. E. Morey, C. N. Seubert, M. J. P. Raatikainen, A. E. Martynyuk, P. Druzgala, P. Milner, M. D. Gonzalez, and D. M. Dennis Structure-Activity Relationships and Electrophysiological Effects of Short-Acting Amiodarone Homologs in Guinea Pig Isolated Heart J. Pharmacol. Exp. Ther., April 1, 2001; 297(1): 260 - 266. [Abstract] [Full Text]
|
|
|
|
|
|
F. L Burton and S. M Cobbe Dispersion of ventricular repolarization and refractory period Cardiovasc Res, April 1, 2001; 50(1): 10 - 23. [Full Text] [PDF]
|
|
|
|
|
|
P M I Sutton, P Taggart, T Opthof, R Coronel, R Trimlett, W Pugsley, and P Kallis Repolarisation and refractoriness during early ischaemia in humans Heart, October 1, 2000; 84(4): 365 - 369. [Abstract] [Full Text]
|
|
|
|
|
|
D. M Roden ELECTROPHYSIOLOGY: Antiarrhythmic drugs: from mechanisms to clinical practice Heart, September 1, 2000; 84(3): 339 - 346. [Full Text] [PDF]
|
|
|
|
 |
|
 J. F. Spear and E. N. Moore Modulation of arrhythmias by isoproterenol in a rabbit heart model of d-sotalol-induced long Q-T intervals Am J Physiol Heart Circ Physiol, July 1, 2000; 279(1): H15 - H25. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. R. Rosen Leaky Dikes and Fibrillating Swine Circulation, November 9, 1999; 100(19): 1942 - 1944. [Full Text] [PDF]
|
|
|
|
|
|
M. M. Rahme, B. Cotter, E. Leistad, M. K. Wadhwa, R. Mohabir, A. P. D. W. Ford, R. M. Eglen, and G. K. Feld Electrophysiological and Antiarrhythmic Effects of the Atrial Selective 5-HT4 Receptor Antagonist RS-100302 in Experimental Atrial Flutter and Fibrillation Circulation, November 9, 1999; 100(19): 2010 - 2017. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. B. Adamson, E. Vanoli, S. S. Hull, R. D. Foreman, and P. J. Schwartz Antifibrillatory efficacy of ersentilide, a novel {beta}-adrenergic and Ikr blocker, in conscious dogs with a healed myocardial infarction Cardiovasc Res, October 1, 1998; 40(1): 56 - 63. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Janse, T. Opthof, and A. G. Kleber Animal models of cardiac arrhythmias Cardiovasc Res, July 1, 1998; 39(1): 165 - 177. [Full Text] [PDF]
|
|
|
|
|
|
C.-T. Tai, S.-A. Chen, A.-N. Feng, W.-C. Yu, Y.-J. Chen, and M.-S. Chang Electropharmacologic Effects of Class I and Class III Antiarrhythmia Drugs on Typical Atrial Flutter : Insights Into the Mechanism of Termination Circulation, May 19, 1998; 97(19): 1935 - 1945. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. F. Spear and E. N. Moore Modulation of quinidine-induced arrhythmias by temperature in perfused rabbit heart Am J Physiol Heart Circ Physiol, March 1, 1998; 274(3): H817 - H828. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. R. Kowey Pharmacological Effects of Antiarrhythmic Drugs: Review and Update Arch Intern Med, February 23, 1998; 158(4): 325 - 332. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Nabauer and S. Kaab Potassium channel down-regulation in heart failure Cardiovasc Res, February 1, 1998; 37(2): 324 - 334. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. S. Stambler, M. A. Wood, and K. A. Ellenbogen Antiarrhythmic Actions of Intravenous Ibutilide Compared With Procainamide During Human Atrial Flutter and Fibrillation : Electrophysiological Determinants of Enhanced Conversion Efficacy Circulation, December 16, 1997; 96(12): 4298 - 4306. [Abstract] [Full Text]
|
|
|
|
 |
|
 A. E. Lacerda, M.-L. Roy, E. W. Lewis, and D. Rampe Interactions of the Nonsedating Antihistamine Loratadine with a Kv1.5-Type Potassium Channel Cloned from Human Heart Mol. Pharmacol., August 1, 1997; 52(2): 314 - 322. [Abstract] [Full Text]
|
|
|
|
|
|
E. P. Anyukhovsky, E. A. Sosunov, and M. R. Rosen Electrophysiologic Effects of Nibentan (HE-11) on Canine Cardiac Tissue J. Pharmacol. Exp. Ther., March 1, 1997; 280(3): 1137 - 1146. [Abstract] [Full Text]
|
|
|
|
|
|
H. Fei, D. Yazmajian, M. S. Hanna, and L. H. Frame Termination of Reentry by Lidocaine in the Tricuspid Ring In Vitro: Role of Cycle-Length Oscillation, Fast Use-Dependent Kinetics, and Fixed Block Circ. Res., February 1, 1997; 80(2): 242 - 252. [Abstract] [Full Text]
|
|
|
|
 |
|
 N. Coupland, S. Wilson, and D. Nutt Antidepressant drugs and the cardiovascular system: a comparison of tricylics and selective serotonin reuptake inhibitors and their relevance for the treatment of psychiatric patients with cardiovascular problems J Psychopharmacol, January 1, 1997; 11(1): 83 - 92. [PDF]
|
|
|
|
|
|
P. Taggart, P. M.I. Sutton, M. R. Boyett, M. Lab, and H. Swanton Human Ventricular Action Potential Duration During Short and Long Cycles: Rapid Modulation by Ischemia Circulation, November 15, 1996; 94(10): 2526 - 2534. [Abstract] [Full Text]
|
|
|
|
|
|
H. Fei, M. S. Hanna, and L. H. Frame Assessing the Excitable Gap in Reentry by Resetting: Implications for Tachycardia Termination by Premature Stimuli and Antiarrhythmic Drugs Circulation, November 1, 1996; 94(9): 2268 - 2277. [Abstract] [Full Text]
|
|
|
|
|
|
D. M. Roden, R. Lazzara, M. Rosen, P. J. Schwartz, J. Towbin, and G. M. Vincent Multiple Mechanisms in the Long-QT Syndrome: Current Knowledge, Gaps, and Future Directions Circulation, October 15, 1996; 94(8): 1996 - 2012. [Abstract] [Full Text]
|
|
|
|
|
|
D. M. Roden Ibutilide and the Treatment of Atrial Arrhythmias: A New Drug-Almost Unheralded-Is Now Available to US Physicians Circulation, October 1, 1996; 94(7): 1499 - 1502. [Full Text]
|
|
|
|
|
|
B. S. Stambler, M. A. Wood, K. A. Ellenbogen, K. T. Perry, L. K. Wakefield, and J. T. VanderLugt Efficacy and Safety of Repeated Intravenous Doses of Ibutilide for Rapid Conversion of Atrial Flutter or Fibrillation Circulation, October 1, 1996; 94(7): 1613 - 1621. [Abstract] [Full Text]
|
|
|
|
|
|
A. Capucci, M. Biffi, G. Boriani, F. Ravelli, G. Nollo, P. Sabbatani, C. Orsi, and B. Magnani Dynamic Electrophysiological Behavior of Human Atria During Paroxysmal Atrial Fibrillation Circulation, September 1, 1995; 92(5): 1193 - 1202. [Abstract] [Full Text]
|
|
|
|
 |
|
 A. H. Glassman, S. P. Roose, and J. T. Bigger Jr The Safety of Tricyclic Antidepressants in Cardiac Patients: Risk-Benefit Reconsidered JAMA, May 26, 1993; 269(20): 2673 - 2675. [Abstract] [PDF]
|
|
|
|
 |
|
 A. M. Katz Cardiac Ion Channels N. Engl. J. Med., April 29, 1993; 328(17): 1244 - 1251. [Full Text]
|
|