Pure class III agents for prevention of sudden cardiac death.
The results of clinical trials in postmyocardial infarction patients using type I antiarrhythmic drugs have been disappointing. There was optimism that IKr blockers might result in a reduction in sudden cardiac death in postinfarct population. Four trials are reviewed here, and the results are variable. The four drugs reviewed--d,l-sotalol, d-sotalol, dofetilide, and azimilide--all share IKr-blocking properties. In addition, d,l-sotalol is a beta-blocker and azimilide is an IKs blocker. The primary uses of d,l-sotalol, dofetilide, and, if approved, azimilide are currently for treatment of atrial fibrillation. Thus, the mortality trials reviewed here are primarily used as support of safety in high-risk patients, because none has achieved a mortality reduction in postinfarction patients. These trials play pivotal roles for regulatory approval of these drugs for use in atrial fibrillation.
Pratt
Craig M
CM
Department of Medicine, Baylor College of Medicine, Houston, Texas, USA. cpratt@bcm.tmc.edu
D000293:Adolescent; D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000145:classification / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D015897:Comorbidity; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000517:prevention & control*; D005060:Europe / Q000453:epidemiology; D006801:Humans; D006827:Hydantoins; D007093:Imidazoles / Q000009:adverse effects / Q000627:therapeutic use*; D048289:Imidazolidines; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D010627:Phenethylamines / Q000009:adverse effects / Q000627:therapeutic use*; D010879:Piperazines / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D013015:Sotalol / Q000009:adverse effects / Q000145:classification / Q000627:therapeutic use*; D013449:Sulfonamides / Q000009:adverse effects / Q000627:therapeutic use*; D016019:Survival Analysis; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D006827:Hydantoins; D007093:Imidazoles; D048289:Imidazolidines; D010627:Phenethylamines; D010879:Piperazines; D013449:Sulfonamides; C086123:azimilide; D013015:Sotalol; C063533:dofetilide