Author + information
- Received July 22, 2008
- Revision received October 8, 2008
- Accepted October 26, 2008
- Published online February 17, 2009.
- Michel Haïssaguerre, MD⁎,⁎ (, )
- Frederic Sacher, MD⁎,
- Akihiko Nogami, MD#,
- Nohiriro Komiya, MD⁎⁎,
- Anne Bernard, MD†,
- Vincent Probst, MD, PhD‡,
- Sinikka Yli-Mayry, MD∥∥,
- Pascal Defaye, MD§,
- Yoshifusa Aizawa, MD††,
- Robert Frank, MD∥,
- Roberto Mantovan, MD‡‡,
- Riccardo Cappato, MD§§,
- Christian Wolpert, MD¶¶,
- Antoine Leenhardt, MD∥,
- Luc de Roy, MD‡‡‡,
- Hein Heidbuchel, MD†††,
- Isabel Deisenhofer, MD##,
- Thomas Arentz, MD⁎⁎⁎,
- Jean-Luc Pasquié, MD, PhD¶,
- Rukshen Weerasooriya, MD⁎,
- Meleze Hocini, MD⁎,
- Pierre Jais, MD⁎,
- Nicolas Derval, MD⁎,
- Pierre Bordachar, MD⁎ and
- Jacques Clémenty, MD⁎
- ⁎Université Bordeaux, CHU Bordeaux, Bordeaux, France
- †Centre Hospitalier Universitaire de Tours, Tours, France
- ‡Centre Hospitalier Universitaire de Nantes, Nantes, France
- §Centre Hospitalier Universitaire de Grenoble, Grenoble, France
- ∥Centre Hospitalier Universitaire de Paris, Paris, France
- ¶Centre Hospitalier Universitaire de Montpellier, Montpellier, France
- #Yokohama Rosai Hospital, Yokohama, Japan
- ⁎⁎Nagasaki University, Nagasaki, Japan
- ††Niigata University School, Niigata, Japan
- ‡‡Treviso Hospital, Treviso, Italy
- §§Policlinico San Donato, Milano, Italy
- ∥∥Tampere University Hospital, Tampere, Finland
- ¶¶University Hospital Mannheim, Mannheim, Germany
- ##University Hospital Herzzentrum Munich, Munich, Germany
- ⁎⁎⁎University Hospital Bad Krozingen, Bad Krozingen, Germany
- †††University Hospital Leuven, Leuven, Belgium
- ‡‡‡Clinique MontGodinne, MontGodinne, Belgium
- ↵⁎Reprint requests and correspondence:
Dr. Michel Haïssaguerre, Hôpital Cardiologique du Haut-Lévêque, 33604 Bordeaux-Pessac, France
Objectives Our purpose was to evaluate the efficacy of antiarrhythmic drugs (AADs) in recurrent ventricular fibrillation (VF) associated with inferolateral early repolarization pattern on the electrocardiogram.
Background Although an implantable cardioverter-defibrillator is the treatment of choice, additional AADs may be necessary to prevent frequent episodes of VF and reduce implantable cardioverter-defibrillator shock burden or as a lifesaving therapy in electrical storms.
Methods From a multicenter cohort of 122 patients (90 male subjects, age 37 ± 12 years) with idiopathic VF and early repolarization abnormality in the inferolateral leads, we selected all patients with more than 3 episodes of VF (multiple) including those with electrical storms (≥3 VF in 24 h). The choice of AAD was decided by individual physicians. Follow-up data were obtained for all patients using monitoring with implantable defibrillator. Successful oral AAD was defined as elimination of all recurrences of VF with a minimal follow-up period of 12 months.
Results Multiple episodes of VF were observed in 33 (27%) patients. Electrical storms (34 ± 47 episodes) occurred in 16 and were unresponsive to beta-blockers (11 of 11), lidocaine/mexiletine (9 of 9), and verapamil (3 of 3), while amiodarone was partially effective (3 of 10). In contrast, isoproterenol infusion immediately suppressed electrical storms in 7 of 7 patients. Over a follow-up of 69 ± 58 months, oral AADs were poorly effective in preventing recurrent VF: beta-blockers (2 of 16), verapamil (0 of 4), mexiletine (0 of 4), amiodarone (1 of 7), and class 1C AADs (2 of 9). Quinidine was successful in 9 of 9 patients, decreasing recurrent VF from 33 ± 35 episodes to nil for 25 ± 18 months. In addition, quinidine restored a normal electrocardiogram.
Conclusions Multiple recurrences of VF occurred in 27% of patients with early repolarization abnormality and may be life threatening. Isoproterenol in acute cases and quinidine in chronic cases are effective AADs.
- early repolarization
- sudden cardiac death
- ventricular fibrillation
- electrical storm
- antiarrhythmic drugs
- Received July 22, 2008.
- Revision received October 8, 2008.
- Accepted October 26, 2008.
- 2009 American College of Cardiology Foundation