Mechanisms and risk factors for proarrhythmia with type Ia compared with Ic antiarrhythmic drug therapy.
Key result
Type Ia antiarrhythmic agents are primarily associated with Torsades de pointes, whereas type Ic agents are most commonly associated with incessant, sustained, monomorphic ventricular tachycardia.
Why the study?
What are the mechanisms and clinical syndromes of proarrhythmia associated with type Ia compared with type Ic antiarrhythmic drug therapy?
Population
Patients receiving antiarrhythmic drug therapy
Comparison
Type Ia antiarrhythmic agents vs Type Ic antiarrhythmic agents
Design
Review
Authors
Discussion
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Member takes
Implication
May guide class-specific proarrhythmia monitoring; leaves open prospective mechanistic validation.
Structured PICO
What are the mechanisms and clinical syndromes of proarrhythmia associated with type Ia compared with type Ic antiarrhythmic drug therapy?
P
Population
Patients receiving antiarrhythmic drug therapy
I
Intervention
Type Ia antiarrhythmic agents
C
Comparator
Type Ic antiarrhythmic agents
O
Outcome
Proarrhythmia (exacerbation of existing arrhythmias or genesis of new arrhythmias)safety
Type Ia and type Ic antiarrhythmic agents produce distinct clinical syndromes of proarrhythmia, reflecting different underlying electrophysiological mechanisms.
Limitations
- General subdivisions of proarrhythmia mechanisms are likely oversimplified with much overlap.
- Proposed mechanisms may not apply to other forms of proarrhythmia such as isolated ventricular premature couplets.
- Clinical syndromes of supraventricular arrhythmias are not sufficiently defined to characterize potential mechanisms.
- Proposed mechanisms may not apply to other forms of proarrhythmia such as increased frequency of isolated ventricular premature couplets
- Clinical syndromes of proarrhythmia during treatment of supraventricular arrhythmias are not sufficiently defined
Cite This Study
Levine et al. (1989) conducted a review in Proarrhythmia. Type Ia and Ic antiarrhythmic drugs was evaluated. Type Ia antiarrhythmic agents are primarily associated with Torsades de pointes, whereas type Ic agents are most commonly associated with incessant, sustained, monomorphic ventricular tachycardia.