Suppression of high-grade ventricular ectopic activity by antiarrhythmic drug treatment as a marker for survival in patients with chronic coronary artery disease.
In order to investigate the relationship between the ease of suppression of complex (frequent multiform, repetitive, and early) ventricular premature beats (VPBs) and subsequent survival, 50 consecutive patients with chronic coronary artery disease (CAD) were followed retrospectively during a mean observation period of 16 months. A total of 124 drug trials were performed using single or combined class I, II, and III antiarrhythmic drugs. Thirty-nine patients were considered "responders" (elimination of Lown classes greater than or equal to IVa and reduction of greater than 30 multiform VPBs to occasional unifocal VPBs during Holter monitoring), whereas in 11 patients VPBs could not be adequately suppressed ("nonresponders"). There were no significant differences in age and congestive heart failure in the two groups. There were three deaths (one sudden) in the 39 "responders" but five deaths (three sudden) in the 11 "nonresponders" (p less than 0.01 for all deaths, p less than 0.05 for sudden deaths). Cumulative probability of survival at 12 months was 0.93 for "responders" and 0.64 for "nonresponders" (p less than 0.005). Significant side effects necessitated drug withdrawal in four patients. Our data suggest that survival in patients with CAD is better when complex VPBs can be suppressed.
D000328:Adult; D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000188:drug therapy*; D003327:Coronary Disease / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008801:Mexiletine / Q000627:therapeutic use; D008875:Middle Aged; D010672:Phenytoin / Q000627:therapeutic use; D011379:Prognosis; D011802:Quinidine / Q000627:therapeutic use; D012189:Retrospective Studies
D000889:Anti-Arrhythmia Agents; D008801:Mexiletine; D010672:Phenytoin; D011802:Quinidine; D000638:Amiodarone