Research Article| Volume 54, ISSUE 4, P2-7, August 13, 1984

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Perspectives on the current treatment of cardiac arrhythmias

  • J.Thomas Bigger Jr.
    Address for reprints: J. Thomas Bigger, Jr., MD, Arrhythmia Control Unit, Columbia-Presbyterian Medical Center, 630 West 168th Street, New York, New York 10032.
    From the Division of Cardiology, Department of Medicine, Columbia University, and the Arrhythmia Control Unit, Columbia-Presbyterian Medical Center, New York, New York USA
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      Our current understanding of human cardiac arrhythmias is primitive and their treatment is largely empirical. For a few arrhythmias for which the mechanism is known, this information is valuable in selecting therapy. Primary methods for arrhythmia detection are 24-hour electrocardiographic recordings, patient-activated recordings, exercise and cardiac electrophysiologic studies. A search for removable causes of arrhythmia should be sought before instituting specific treatment with antiarrhythmic drugs, surgery or implantable devices. Over the past 20 years, the spectrum of antiarrhythmic drug action has broadened; sodium channel blockers, β-adrenergic blockers and calcium channel blockers have extended our therapeutic options, but the ideal drug has yet to appear. Efficacy and convenience of antiarrhythmic drugs have improved significantly, but adverse effects and drug interactions still occur much too frequently. The outlook for patients with malignant arrhythmias has improved significantly. However, the 2 methods for evaluating therapy of malignant arrhythmias are time-consuming, uncomfortable and expensive. Basic and clinical research is rapidly advancing our knowledge and effectiveness in dealing with cardiac arrhythmias. As a result, we can expect substantial improvements in arrhythmia control in the future.
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        • Fisher J.D.
        • Kim S.G.
        • Furman S
        • Matos J.A.
        Role of implantabte pacemakers in control of recurrent ventricular tachycardia.
        Am J Cardiol. 1982; 49: 194-206
        • Sealy W.C.
        • Gallagher J.J.
        The surgical approach to the septal area of the heart based on the experiences with forty-five patients with Kent bundles.
        J Thorac Cardiovasc Surg. 1980; 79: 542-555
        • Horowitz L.N.
        • Harken A.H.
        • Kastor J.A.
        • Josephson M.E.
        Ventricular resections guided by epicardial and endocardial mapping for the treatment of recurrent ventricular tachycardia.
        N Engl J Med. 1980; 302: 589-593
        • Mirowski M
        • Reid P.R.
        • Mower M.M.
        • Watkins L
        • Gott V.L.
        • Schauble J.F.
        • Langer A
        • Hellman M.S.
        • Kolenik S.A.
        • Fischell R.E.
        • Weisfeldt M.L.
        Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human beings.
        N Engl J Med. 1980; 303: 322-324
        • Heger J.J.
        • Prystsowsky E.N.
        • Jackman W.M.
        • Naccarelli G.V.
        • Warfel K.A.
        • Rinkenberger R.L.
        • Zipes D.P.
        Amiodarone: clinical efficacy and electrophysiology during long-term therapy for recurrent ventricular tachycardia or ventricular fibrillation.
        N Engl J Med. 1981; 305: 539-545
        • Braunwald E
        Mechanism of action of calcium channel blocking agents.
        N Engl J Med. 1982; 307: 1618-1627
        • Antman E.M.
        • Stone P.H.
        • Muller J.E.
        • Braunwald E
        Calcium channel blocking agents in the treatment of cardiovascular disorders. Part I. Basic and clinical electrophysiologic effects.
        Ann Intern Med. 1980; 93: 875-885
        • Roden D.M.
        • Reele S.B.
        • Higgins S.B.
        • Mayol R.F.
        • Gammans R.E.
        • Oates J.A.
        • Woosley R.L.
        Total suppression of ventricular arrhythmias by encainide.
        N Engl J Med. 1980; 302: 877-887
        • Anderson J.L.
        • Stewart J.R.
        • Perry B.A.
        • Van Hamersveld D.D.
        • Johnson T.A.
        • Conard G.J.
        • Chang S.F.
        • Kvam D.C.
        • Pitt B
        Oral flecainide acetate for the treatment of ventricular arrhythmias.
        N Engl J Med. 1981; 305: 474-477
        • Duff H.J.
        • Roden D.M.
        • Maffucci R.J.
        • Vesper B.S.
        • Conard G.J.
        • Higgins S.B.
        • Oates J.A.
        • Smith R.F.
        • Woosley R.L.
        Suppression of resistant ventricular arrhythmias by twice daily dosing with flecainide.
        Am J Cardiol. 1981; 48: 1133-1140
        • Keefe D.L.
        • Peters F
        • Winkle R.A.
        Randomized double-blind placebo controlled crossover trial documenting oral lorcainide efficacy in suppression of symptomatic ventricular tachyarrhythmias.
        Am Heart J. 1982; 103: 511-518
        • Kass R.S.
        • Lederer W.J.
        • Tsien R.W.
        • Weingart R
        Ionic basis of transient inward current induced by strophanthidin in cardiac Purkinje fibers.
        J Physiol. 1978; 281: 209-226
        • Bigger Jr, J.T.
        • Giardina E.G.V.
        Rational use of antiarrhythmic drugs alone and in combination.
        in: Melmon K.L. Cardiovascular Drug Therapy. FA Davis, Philadelphia1974: 103-117
        • Bigger Jr, J.T.
        • Huffman B.F.
        Antiarrhythmic drugs.
        (Chap 31)in: Gilman A.G. Goodman L.S. Gilman A The Pharmacological Basis of Therapeutics. 6th Ed. 1980: 761-792 (New York)
        • Leahey Jr, E.B.
        • Heissenbuttel R.H.
        • Glardina E.G.V.
        • Bigger Jr, J.T.
        Combined mexiletine and propranolol treatment of refractory ventricular tachycardia.
        Br Med J. 1980; 281: 357-358
        • Duff H.J.
        • Rosen D
        • Drimon K
        • Oates J.A.
        • Woosley R.L.
        Mexiletine in the treatment of resistant ventricular arrhythmias: enhancement of efficacy in reduction of dose related side effects in combination with quinidine.
        Circulation. 1983; 57: 1124-1128
        • Data J.L.
        • Wilkinson G.R.
        • Nies A.S.
        Interaction of quinidine with anticonvulsant drugs.
        N Engl J Med. 1976; 294: 699-702
        • Bigger Jr, J.T.
        • Leahey Jr, E.B.
        Quinidine and digoxin, an important interaction.
        Drugs. 1982; 24: 229-239
        • Leahey Jr, E.B.
        • Bigger Jr, J.T.
        • Butler Jr, V.P.
        • Reiffel J.A.
        • O'Conneil G.C.
        • Scaffidi L.E.
        • Rottman J.N.
        Quinidine-digoxin interaction. Time course and pharmacokinetics.
        Am J Cardiol. 1981; 48: 1141-1146
        • Warner N.J.
        • Barnard J.T.
        • Uhi E.W.
        • Bigger Jr, J.T.
        Digoxin, quinidine and monovalent cation transport (abstr).
        Circulation. 1982; 66: II-57
        • Glardina E.G.V.
        • Bigger Jr, J.T.
        Antiarrhythmic effect of imipramine hydrochloride in patients with ventricular premature complexes without psychological depression.
        Am J Cardiol. 1982; 50: 172-179
        • Barnard J.T.
        • Glardina E.G.V.
        • Bigger Jr, J.T.
        The antiarrhythmic and chronotropic effects of nortriptyline in cardiac patients (abstr).
        Circulation. 1982; 66: II-143
        • Mitchell J.R.
        • Cavanaugh J.H.
        • Arias L
        • Oates J.A.
        Guanethidine and related agents. III. Antagonism by drugs which inhibit the norepinephrine pump in man.
        J Clin invest. 1970; 49: 1596-1604
        • Branch R.A.
        • Shand D.G.
        • Wilkinson G.R.
        • Nies A.S.
        The reduction in Iidocaine clearance by dl-propranolol: an example of hemodynamic drug interaction.
        J Pharmacol Exp Ther. 1973; 184: 515-519
        • Feely J
        • Wilkinson G.R.
        • McAllister C.B.
        • Wood A.J.J.
        Increased toxicity and reduced clearance of lidocaine by cimetidine.
        Ann Intern Med. 1982; 96: 592-594
        • Neuvonen P.J.
        • Tokola R.H.
        • Kaste M
        Cimetidine-phenytoin interaction: effect on serum phenytoin concentration and antipyrine test.
        Eur J Clin Pharmacol. 1981; 21: 215-220
        • Feely J
        • Wilkinson G.R.
        • Wood A.J.J.
        Reduction of liver blood flow and propranolol metabolism by cimetidine.
        N Engl J Med. 1981; 304: 692-695
        • Horowitz L.N.
        • Josephson M.E.
        • Kastor J.A.
        Intracardiac electrophysiologic studies as a method for the optimization of drug therapy in chronic ventricular arrhythmia.
        Prog Cardiovasc Dis. 1980; 23: 81-98
        • Swerdlow C.D.
        • Echt D.S.
        • Winkle R.A.
        • Mason J.W.
        Determinants of survival in patients with ventricular tachyarrhythmias.
        N Engl J Med. 1983; 308: 1436-1447
        • Llivelli F.D.
        • Bigger Jr, J.T.
        • Relffel J.A.
        • Gang E.S.
        • Patton J.N.
        • Noethling P.M.
        • Roinitzky L.M.
        • Gliklich J.I.
        Response to programmed ventricular stimulation: sensitivity, specificity and relationship to heart disease.
        Am J Cardiol. 1982; 50: 452-458
        • Ruskin J.N.
        Antiarrhythmic drugs: a possible cause of out-of-hospital cardiac arrest.
        N Engl J Med. 1983; 309: 1302-1306
        • Graboys T.B.
        • Lown B
        • Podrid P.J.
        • DeSilva R
        Long-term survival of patients with ventricular arrhythmia treated with antiarrhythmic drugs.
        Am J Cardiol. 1982; 50: 437-443