Chronic ventricular arrhythmias: which drug for which patient?
Many agents, including a number of drugs recently approved by the Food and Drug Administration, are now available for the treatment of chronic ventricular arrhythmias. The so-called first-generation agents--quinidine, procainamide and disopyramide--have been used in large numbers of patients for many years, and the safety and efficacy profiles of these drugs are well established. The "second-generation" antiarrhythmic agents recently approved by the Food and Drug Administration offer promising new alternatives; however, their safety and efficacy profiles have yet to be confirmed for broad populations over extended periods of time. Although it is recognized that the choice of agent for treatment of a particular patient is a "therapeutic trial," with an unpredictable outcome of efficacy and adverse effects, certain "descriptors," such as patient age or co-existing medical conditions, are often helpful in determining which agent is most likely to be clinically effective, and which agents are most likely to produce adverse effects. When other medical conditions such as hepatic or renal failure are present, the appropriate choice of drug and dosage is required for optimal management of the arrhythmia and for prevention of overdosage, exacerbation of other medical problems and deleterious interactions. Combination therapy with multiple antiarrhythmic agents is often quite effective for increasing arrhythmia control without increasing adverse effects. However dosage modifications are often necessary when an antiarrhythmic drug is given in conjunction with another such agent, or with agents that also have electrophysiologic activity or modify metabolic or elimination functions. The following report is one clinician's approach for optimizing efficacy and minimizing toxicity while using the difficult class of drugs called antiarrhythmic agents. It will encourage the use of certain drugs before others, based on considerations of efficacy, safety, ease of administration, follow-up, and other factors.
DiBianco
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Cardiology Department, Washington Adventist Hospital, Takoma Park, Maryland 20912.
D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000188:drug therapy*; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D006801:Humans; D013610:Tachycardia / Q000188:drug therapy
D000889:Anti-Arrhythmia Agents