Key result
Quinidine consistently suppresses ventricular arrhythmias and terminates electrical storms in J-wave and idiopathic VF syndromes.
Why the study?
Although quinidine was withdrawn in many countries due to increased mortality and proarrhythmic risk, recent studies show its efficacy in specific ventricular arrhythmia syndromes, prompting a review of the arguments for and against its use.
Does oral quinidine prevent recurrent ventricular arrhythmias and terminate ventricular fibrillation storms in patients with channelopathies such as Brugada syndrome, idiopathic ventricular fibrillation, early repolarization syndrome, and short QT syndrome?
Does oral quinidine prevent recurrent ventricular arrhythmias and terminate ventricular fibrillation storms in patients with channelopathies such as Brugada syndrome, idiopathic ventricular fibrillation, early repolarization syndrome, and short QT syndrome?
Despite historical withdrawal due to mortality risks and adverse effects, quinidine remains the only oral antiarrhythmic consistently effective for preventing recurrent VF storms in Brugada syndrome, idiopathic VF, and early repolarization syndrome, and for normalizing QT in congenital short QT syndrome.
Answers are grounded in this paper and cite their sources.
May support quinidine for refractory VF storms in these syndromes; leaves open randomized trials to confirm net benefit.
Historically, quinidine was the first medicine used in the therapy of heart arrhythmias. Studies in the early 20th century identified quinidine, a diastereomer of the antimalarial quinine, as the most potent of the antiarrhythmic substances extracted from the cinchona plant. Quinidine is used by the 1920s, as an antiarrhythmic agent to maintain sinus rhythm after the conversion from atrial flutter or atrial fibrillation and to prevent recurrence of ventricular tachycardia or ventricular fibrillation. Its value in chronic prophylaxis of relapse of ventricular arrhythmia was brought under suspicion after publishing of meta analysis that showed that the application of quinidine increases mortality. Due to numerous proofs of increased risk for the appearance of ventricular arrhythmia and sudden death, as well as a number of other adverse effects and drug interactions, quinidine was withdrawn from use and in the recent years has become unavailable in many countries. On the other hand, recent studies have demonstrated that quinidine is the only oral medication that has consistently shown efficacy in preventing arrhythmias and terminating storms due to recurrent ventricular fibrillation, in patients with Brugada syndrome, idiopathic ventricular fibrillation and early repolarization syndrome. Quinidine is also the only antiarrhythmic drug that normalized the QT interval in patients with the congenital short QT syndrome. The aim of this review is to provide good insight into pro and contra arguments for quinidine use in ventricular arrhythmias evidence based on recently published literature.
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Božić et al. (2018) conducted a review in Ventricular arrhythmias (including Brugada syndrome, idiopathic ventricular fibrillation, early repolarization syndrome, and congenital short QT syndrome). Quinidine was evaluated on Prevention of recurrent ventricular arrhythmias and termination of ventricular fibrillation storms. Quinidine consistently prevents arrhythmias and terminates recurrent ventricular fibrillation storms in Brugada, idiopathic VF, and early repolarization syndromes.
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