Circulation, Vol 86, 29-37, Copyright © 1992 by American Heart Association
T Wichter, M Borggrefe, W Haverkamp, X Chen and G Breithardt
BACKGROUND. Ventricular tachyarrhythmias are the major clinical
manifestation of arrhythmogenic right ventricular disease. Although
antiarrhythmic therapy has been widely advocated, there is only limited
information available on the efficacy of antiarrhythmic drugs in these
patients. METHODS AND RESULTS. The short- and long-term efficacies of
various antiarrhythmic agents were retrospectively and prospectively
analyzed in 81 patients (mean age, 39 +/- 14 years; range, 16-68 years;
61.7% males) with arrhythmogenic right ventricular disease. In 42 patients
with inducible ventricular tachycardia during programmed ventricular
stimulation, the following efficacy rates were obtained: class Ia and Ib
drugs (n = 18), 5.6%; class Ic drugs (n = 25), 12%; beta-blockers (n = 8),
0%; sotalol (n = 38), 68.4%; amiodarone (n = 13), 15.4%; verapamil (n = 5),
0%; and drug combinations (n = 26), 15.4%. Only one of the 10 patients not
responding to sotalol was treated effectively by amiodarone, whereas the
remaining nine patients proved to be drug refractory toward all other drugs
tested (3.8 +/- 2.3 drugs, including amiodarone in five cases) and
underwent nonpharmacological therapy. During a follow-up of 34 +/- 25
months, three of the 31 patients (9.7%) discharged on pharmacological
therapy had nonfatal recurrences of ventricular tachycardia after 0.5, 51,
and 63 months, respectively. In 39 patients with noninducible ventricular
tachycardia during programmed ventricular stimulation, the following
efficacy rates were observed: class Ia and Ib drugs (n = 16), 0%; class Ic
agents (n = 23), 17.4%; beta-blockers (n = 7), 28.6%; sotalol (n = 35),
82.8%; amiodarone (n = 4), 25%; verapamil (n = 24), 50%; and drug
combinations (n = 11), 9.1%. During a follow-up of 14 +/- 13 months, four
of 33 patients (12.1%) discharged on antiarrhythmic drugs had nonfatal
relapses of their clinical ventricular arrhythmia. CONCLUSIONS. Thus, in
arrhythmogenic right ventricular disease, sotalol proved to be highly
effective in patients with inducible as well as noninducible ventricular
tachycardia. Patients with inducible ventricular tachycardia not responding
to sotalol are likely to not respond to other antiarrhythmic drugs and
should be considered for nonpharmacological therapy without further drug
testing. Amiodarone did not prove to be more effective than sotalol and may
not be an alternative because of frequent side effects during long-term
therapy, especially in young patients. Verapamil and beta-blockers were
effective in a considerable number of patients with noninducible
ventricular tachycardia and may be a therapeutic alternative in this
subgroup. Class I agents appear to be rarely effective in the treatment of
both inducible and noninducible ventricular tachycardia in arrhythmogenic
right ventricular disease.
ARTICLES
Efficacy of antiarrhythmic drugs in patients with arrhythmogenic right ventricular disease. Results in patients with inducible and noninducible ventricular tachycardia
Hospital of the Westfalische Wilhelms-University, Department of Cardiology and Angiology, Munster, Germany.
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