Circulation, Vol 65, 886-894, Copyright © 1982 by American Heart Association
V Velebit, P Podrid, B Lown, BH Cohen and TB Graboys
Antiarrhythmic drugs may aggravate or even induce ventricular arrhythmias.
This type of adverse reaction is becoming more prevalent as the use of
antiarrhythmic agents becomes more widespread. In a retrospective analysis
of antiarrhythmic drug action, a worsening of arrhythmia was observed in 80
of 722 (11.1%) antiarrhythmic drug tests in 53 of 155 patients being
treated for ventricular tachyarrhythmias. Aggravation of arrhythmias was
defined by occurrence of a fourfold increase in the frequency of
ventricular premature complexes, a 10-fold increase in repetitive forms, or
the first emergence of sustained ventricular tachycardia coincident with
time course of action of the particular drug under study. Such aggravation
was noted with each of nine drugs tested: quinidine, procainamide,
disopyramide, propranolol, metoprolol, aprindine, mexiletine, tocainide and
pindolol. The frequency of this complication for a specific drug ranged
from 5.9- 15.8%. Blood drug concentrations were consistently in the
therapeutic range. A study of the variability of ventricular arrhythmia
during 48- hour Holter monitoring and exercise stress testing in no
instance showed arrhythmia enhancement commensurate with that defining
aggravation. Our data suggest that this potentially serious complication is
not readily predictable and requires a systematic approach to
antiarrhythmic drug testing before a patient is prescribed a long-range
maintenance program.
ARTICLES
Aggravation and provocation of ventricular arrhythmias by antiarrhythmic drugs
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