Circulation, Vol 59, 855-863, Copyright © 1979 by American Heart Association
RJ Myerburg, C Conde, DS Sheps, RA Appel, I Kiem, RJ Sung and A Castellanos
We studied the long-term effects of membrane-active antiarrhythmic agents
on chronic ventricular arrhythmias in patients who have survived
prehospital cardiac arrest. Among 16 patients treated with a dose-
adjusted, plasma level-monitored antiarrhythmic regimen, eight have
survived for longer than 12 months and eight have had recurrent cardiac
arrests (RCAs). Monthly Holter monitor tapes (HM) recorded during the 4
months before the eight RCAs were compared with monthly HM tapes matched
for time of entry and duration of follow-up in the eight patients who did
not have RCAs. Transient or persistent complex ventricular ectopic
depolarizations (VEDs) have been recorded on 47 of the 63 monthly HM tapes
(75%). The difference between VEDs in the RCA patients (mean 153 VEDs/hr,
median 19 VEDs/hr) and VEDs in the patients who have not had RCA (mean 122
VEDs/hr, median 8 VEDs/hr) was not significant (p less than 0.2); nor was
there a predictable relationship between therapeutic plasma levels of
antiarrhythmic agents and the frequency and complexity of chronic
asymptomatic VEDs (therapeutic levels--mean 104 VEDs/hr, median 6 VEDs/hr;
subtherapeutic levels--mean 184 VEDs/hr, median 21 VEDs/hr). Differences
were not significant (p greater than 0.1). In contrast, all eight RCA
patients had unstable plasma levels (21 of 31 determinations
subtherapeutic) while six of the eight patients who have not had RCA had
consistently therapeutic levels (p less than 0.01). Thus, adequate plasma
levels of antiarrhythmic agents may protect against RCA, despite failure to
suppress VEDs predictably. The apparent dissociation between predictable
suppression of chronic VEDs and protection against RCA suggests that
clinical effectiveness of these agents may not be best measured by their
effect on chronic VEDs.
ARTICLES
Antiarrhythmic drug therapy in survivors of prehospital cardiac arrest: comparison of effects on chronic ventricular arrhythmias and recurrent cardiac arrest
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