Quinidine therapy successfully suppressed arrhythmic storms refractory to conventional antiarrhythmics in patients with coronary disease, with 0% recurrence during therapy vs 16% without quinidine.
Observational (n=43)
Does quinidine therapy prevent recurrent polymorphic ventricular tachycardia and improve survival in patients with coronary artery disease and arrhythmic storms refractory to conventional therapy?
Quinidine is highly effective for treating arrhythmic storms of polymorphic ventricular tachycardia in patients with coronary artery disease when conventional therapies like amiodarone fail.
Absolute Event Rate: 0% vs 16%
BACKGROUND: Polymorphic ventricular tachycardia (VT) without QT prolongation is well described in patients without structural heart disease (mainly idiopathic ventricular fibrillation and Brugada syndrome) and in patients with acute ST-elevation myocardial infarction. METHODS: Retrospective study of patients with polymorphic VT related to coronary artery disease, but without evidence of acute myocardial ischemia. RESULTS: The authors identified 43 patients in whom polymorphic VT developed within days of an otherwise uncomplicated myocardial infarction or coronary revascularization procedure. The polymorphic VT events were invariably triggered by extrasystoles with short (364±36 ms) coupling interval. Arrhythmic storms (4-16 events of polymorphic VT deteriorating to ventricular fibrillation) occurred in 23 (53%) patients. These arrhythmic storms were always refractory to conventional antiarrhythmic therapy, including intravenous amiodarone, but invariably responded to quinidine therapy. In-hospital mortality was 17% for patients with arrhythmic storm. Patients treated with quinidine invariably survived to hospital discharge. During long-term follow-up (of 5.6±6 years; range, 1 month to 18 years), 3 (16%) of patients discharged without quinidine developed recurrent polymorphic VT. There were no recurrent arrhythmias during quinidine therapy Conclusions: Arrhythmic storm with recurrent polymorphic VT in patients with coronary disease responds to quinidine therapy when other antiarrhythmic drugs (including intravenous amiodarone) fail.
Viskin et al. (Wed,) conducted a observational in Polymorphic ventricular tachycardia with coronary heart disease (n=43). Quinidine vs. Conventional antiarrhythmic therapy / no quinidine was evaluated on Recurrent polymorphic VT during long-term follow-up. Quinidine therapy successfully suppressed arrhythmic storms refractory to conventional antiarrhythmics in patients with coronary disease, with 0% recurrence during therapy vs 16% without quinidine.