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Abstract
Sudden cardiac death continues to be a major health hazard. Control of the problem
requires identification of those at risk and effective therapy for prevention. Studies
have shown that in patients with coronary disease or cardiomyopathy, salvos of ventricular
tachycardia are an independent risk factor for sudden death. Therefore, the objective
of therapy is the suppression of these forms. A large number of antiarrhythmic drugs
are available, but there are no guidelines for the selection of an effective and well-tolerated
agent. We have developed a systematic approach to drug selection which includes 4
phases: phase 0 is a control period to establish the prevalence and density of the
arrhythmia; phase 1, acute drug testing, is designed to screen a number of drugs for
effectiveness; during phase 2 the drug is administered for a brief period to evaluate
efficacy and tolerance; phase 3, once the drug is determined to be well tolerated
and effective, it is continued as part of a long-term program. This approach was applied
in 76 patients who underwent testing with lorcainide. This drug was continued long
term in 15 patients. After 23 months of follow-up, only 1 patient died suddenly. Therefore,
patients with life-threatening ventricular arrhythmia can be protected from a recurrence
by individualized drug therapy.
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Article info
Footnotes
☆This study was supported in part by Grant HL-07776 from the National Heart, Lung and Blood Institute, National Institutes of Health, U.S. Public Health Service, Bethesda, Maryland, and The Rappaport International Program of Cardiology.
Identification
Copyright
© 1984 Published by Elsevier Inc.
