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May 18, 2026Journal of the American College of Cardiology

Characteristics of Recurrent Ventricular Fibrillation Associated With Inferolateral Early Repolarization

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Why the study?

Although implantable cardioverter-defibrillators are standard treatment, additional antiarrhythmic drugs may be needed to prevent recurrent ventricular fibrillation episodes or electrical storms associated with inferolateral early repolarization.

Do specific antiarrhythmic drugs prevent recurrent ventricular fibrillation in patients with idiopathic VF and inferolateral early repolarization?

Population

122 patients with idiopathic VF and inferolateral early repolarization abnormality

Comparison

Physician-selected antiarrhythmic drugs for recurrent VF or electrical storms

Design

Multicenter cohort study

Follow-up

69 +/- 58 months

Key result

Isoproterenol suppressed electrical storms in 7 of 7 acute cases, and quinidine eliminated recurrent VF in 9 of 9 chronic cases, whereas other antiarrhythmic drugs were poorly effective.

Authors

MHMichel Haı̈ssaguerreFSFrédéric SacherANAkihiko Nogami

Discussion

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Overview

May guide therapy in refractory early repolarization VF; hypothesis-generating and requires randomized confirmation.

Key Points

  • This study aims to assess the effectiveness of various antiarrhythmic drugs in preventing recurrent ventricular fibrillation associated with inferolateral early repolarization.
  • Multicenter cohort study with 122 patients exhibiting idiopathic VF and early repolarization abnormalities
  • Patients selected had more than 3 episodes of VF, including electrical storms
  • Follow-up data collected using monitoring with implantable defibrillators
  • Recurrent VF occurred in 27% of patients; electrical storms unresponsive to common AADs such as beta-blockers and lidocaine
  • Quinidine successfully eliminated VF episodes in all 9 patients while lowering the frequency from an average of 33 episodes to nil for over 25 months
  • Isoproterenol effectively suppressed electrical storms in all 7 patients tested

Study Design

Type

Cohort (n=122)

Multicenter

Yes

Structured PICO

Do specific antiarrhythmic drugs prevent recurrent ventricular fibrillation in patients with idiopathic VF and inferolateral early repolarization?

P
Population
122 patients (90 male, age 37 +/- 12 years) with idiopathic ventricular fibrillation (VF) and early repolarization abnormality in the inferolateral leads, specifically focusing on 33 patients with multiple (>3) episodes of VF including 16 with electrical storms.
I
Intervention
Various antiarrhythmic drugs (AADs) chosen by individual physicians, including isoproterenol (acute), quinidine (chronic), beta-blockers, lidocaine/mexiletine, verapamil, amiodarone, and class 1C AADs.
O
Outcome
Successful oral AAD therapy, defined as elimination of all recurrences of VF with a minimal follow-up period of 12 months.hard clinical

Isoproterenol and quinidine are highly effective for the acute and chronic suppression, respectively, of recurrent ventricular fibrillation in patients with inferolateral early repolarization.

Cite This Study

Haı̈ssaguerre et al. (2009) conducted a cohort in Idiopathic ventricular fibrillation with inferolateral early repolarization (n=122). Antiarrhythmic drugs (isoproterenol, quinidine) was evaluated on Elimination of all recurrences of VF with a minimal follow-up period of 12 months. Isoproterenol suppressed electrical storms in 7 of 7 acute cases, and quinidine eliminated recurrent VF in 9 of 9 chronic cases, whereas other antiarrhythmic drugs were poorly effective.

synapsesocial.com/papers/6a0b2de33a96fd342f4319bfhttps://doi.org/10.1016/j.jacc.2008.10.044
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Electrical Substrate Ablation for Refractory Ventricular Fibrillation2021 · 12 citations
  2. 2Electrophysiological Findings in Idiopathic Recurrent Ventricular Fibrillation: Special Reference to Mode of Induction, Drug Testing, and Long‐Term Outcomes1996 · 31 citations
  3. 3Catheter Ablation of Frequently Recurring Ventricular Fibrillation in a Patient after Aortic Valve Repair2004 · 29 citations
  4. 4Repolarization Dynamics in Patients with Idiopathic Ventricular Fibrillation2005 · 63 citations
  5. 5Management of Ventricular Fibrillation with Transvenous Defibrillators Without Baseline Electrophysiologic Testing or Antiarrhythmic Drugs1996 · 19 citations