Clinical evaluation of the use-dependent QRS prolongation and the reverse use-dependent QT prolongation of class I and class III antiarrhythmic agents and their value in predicting efficacy.
We measured the QRS duration during a treadmill exercise test and the QT interval using a 24-hour Holter electrocardiogram at various heart rates to identify use-dependent QRS prolongation and reverse use-dependent QT prolongation of class I and III antiarrhythmic drugs. Use-dependent QRS prolongation was detected in 61%, 53%, and 64% of patients receiving disopyramide, mexiletine, and pilsicainide, respectively. Reverse use-dependent QT prolongation was found in 40% and 70% of patients receiving disopyramide and E4031. Drugs suppressed > or = 75% of the total premature ventricular contractions in all patients who had both use-dependent QRS prolongation and reverse use-dependent QT prolongation, in 79% of patients with use-dependent QRS prolongation alone, in 70% with reverse use-dependent QT prolongation alone, and in 11% with neither use-dependent QRS prolongation nor reverse use-dependent QT prolongation. Use-dependent QRS prolongation and reverse use-dependent QT prolongation were identified noninvasively and were useful in evaluating antiarrhythmic efficacy.
Department of Medicine, Keio University, School of Medicine, Tokyo, Japan.
T
T
Sadanaga
S
S
Ogawa
Y
Y
Okada
N
N
Tsutsumi
S
S
Iwanaga
T
T
Yoshikawa
M
M
Akaishi
S
S
Handa
D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced / Q000188:drug therapy / Q000503:physiopathology*; D004206:Disopyramide / Q000494:pharmacology / Q000627:therapeutic use; D004341:Drug Evaluation / Q000379:methods; D015716:Electrocardiography, Ambulatory / Q000187:drug effects*; D005080:Exercise Test; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008012:Lidocaine / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D008801:Mexiletine / Q000494:pharmacology / Q000627:therapeutic use; D008875:Middle Aged; D010880:Piperidines / Q000494:pharmacology / Q000627:therapeutic use; D015221:Potassium Channels / Q000187:drug effects; D011725:Pyridines / Q000494:pharmacology / Q000627:therapeutic use; D015222:Sodium Channels / Q000187:drug effects
D000889:Anti-Arrhythmia Agents; D010880:Piperidines; D015221:Potassium Channels; D011725:Pyridines; D015222:Sodium Channels; C063968:E 4031; D008801:Mexiletine; D008012:Lidocaine; C042288:pilsicainide; D004206:Disopyramide