Key result
Cibenzoline doubles short-term PVD suppression vs quinidine, but efficacy wanes beyond three months.
Why the study?
The comparative efficacy and long-term effects of cibenzoline versus quinidine in patients with frequent premature ventricular depolarizations were unclear.
Does cibenzoline reduce premature ventricular depolarizations in patients with frequent PVDs compared to quinidine?
RCT (n=20)
Open-label
Does cibenzoline reduce premature ventricular depolarizations in patients with frequent PVDs compared to quinidine?
Absolute Event Rate: 40% vs 20%
Cibenzoline is slightly superior to quinidine for short-term suppression of frequent premature ventricular depolarizations, but its long-term efficacy wanes after three months.
Cibenzoline was associated with short-term PVD suppression over quinidine in this cohort; leaves open durability and requires randomized confirmation before practice change.
Cibenzoline, a new class I antiarrhythmic drug, was compared with quinidine in an open crossover study of 20 patients with frequent (greater than 30/hr) premature ventricular depolarizations (PVDs). Eight patients treated with cibenzoline experienced more than 75% reduction in PVD frequency. Cibenzoline completely suppressed ventricular couplets in eight of 17 patients and inhibited ventricular tachycardia (VT) in four of 13 patients. Only four patients (20%) responded to quinidine with a similar reduction in PVDs. Quinidine completely suppressed ventricular couplets in eight of 17 patients and episodes of VT in six of 13 patients. Cibenzoline prolonged PR, QRS, and QTc intervals. Eight patients who had shown more than a 75% reduction of PVDs were treated with cibenzoline for an extended period. At the end of three months, only five of eight patients continued to have 75% or greater reduction of PVDs. At the end of six and 12 months, four of five patients continued to have 75% or greater reduction of PVDs. Cibenzoline was similarly effective in suppressing complex arrhythmias. Thus, cibenzoline was only slightly superior to quinidine in suppressing ventricular arrhythmias. With long-term use of cibenzoline, significant PVD suppression was noted at the end of three months but not afterward.
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Palakurthy et al. (1987) conducted an RCT in Frequent premature ventricular depolarizations (n=20). Cibenzoline vs. Quinidine was evaluated on >75% reduction in PVD frequency. Cibenzoline achieved >75% reduction in premature ventricular depolarizations in 40% of patients compared to 20% with quinidine, but significant suppression was not maintained beyond three months.
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