Management of malignant ventricular arrhythmia--experience with lorcainide.
Sudden cardiac death continues to be a major health hazard. Control of the problem requires identification of those at risk and effective therapy for prevention. Studies have shown that in patients with coronary disease or cardiomyopathy, salvos of ventricular tachycardia are an independent risk factor for sudden death. Therefore, the objective of therapy is the suppression of these forms. A large number of antiarrhythmic drugs are available, but there are no guidelines for the selection of an effective and well-tolerated agent. We have developed a systematic approach to drug selection which includes 4 phases: phase 0 is a control period to establish the prevalence and density of the arrhythmia; phase 1, acute drug testing, is designed to screen a number of drugs for effectiveness; during phase 2 the drug is administered for a brief period to evaluate efficacy and tolerance; phase 3, once the drug is determined to be well tolerated and effective, it is continued as part of a long-term program. This approach was applied in 76 patients who underwent testing with lorcainide. This drug was continued long term in 15 patients. After 23 months of follow-up, only 1 patient died suddenly. Therefore, patients with life-threatening ventricular arrhythmia can be protected from a recurrence by individualized drug therapy.
D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000188:drug therapy*; D044482:Benzeneacetamides; D004305:Dose-Response Relationship, Drug; D004341:Drug Evaluation / Q000379:methods; D004594:Electrophysiology; D005500:Follow-Up Studies; D006352:Heart Ventricles; D006801:Humans; D008991:Monitoring, Physiologic; D010880:Piperidines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D000889:Anti-Arrhythmia Agents; D044482:Benzeneacetamides; D010880:Piperidines; C015970:lorcainide