Characteristics of recurrent ventricular fibrillation associated with inferolateral early repolarization role of drug therapy.
OBJECTIVE
Our purpose was to evaluate the efficacy of antiarrhythmic drugs (AADs) in recurrent ventricular fibrillation (VF) associated with inferolateral early repolarization pattern on the electrocardiogram.


BACKGROUND
Although an implantable cardioverter-defibrillator is the treatment of choice, additional AADs may be necessary to prevent frequent episodes of VF and reduce implantable cardioverter-defibrillator shock burden or as a lifesaving therapy in electrical storms.


METHODS
From a multicenter cohort of 122 patients (90 male subjects, age 37 +/- 12 years) with idiopathic VF and early repolarization abnormality in the inferolateral leads, we selected all patients with more than 3 episodes of VF (multiple) including those with electrical storms (> or =3 VF in 24 h). The choice of AAD was decided by individual physicians. Follow-up data were obtained for all patients using monitoring with implantable defibrillator. Successful oral AAD was defined as elimination of all recurrences of VF with a minimal follow-up period of 12 months.


RESULTS
Multiple episodes of VF were observed in 33 (27%) patients. Electrical storms (34 +/- 47 episodes) occurred in 16 and were unresponsive to beta-blockers (11 of 11), lidocaine/mexiletine (9 of 9), and verapamil (3 of 3), while amiodarone was partially effective (3 of 10). In contrast, isoproterenol infusion immediately suppressed electrical storms in 7 of 7 patients. Over a follow-up of 69 +/- 58 months, oral AADs were poorly effective in preventing recurrent VF: beta-blockers (2 of 16), verapamil (0 of 4), mexiletine (0 of 4), amiodarone (1 of 7), and class 1C AADs (2 of 9). Quinidine was successful in 9 of 9 patients, decreasing recurrent VF from 33 +/- 35 episodes to nil for 25 +/- 18 months. In addition, quinidine restored a normal electrocardiogram.


CONCLUSIONS
Multiple recurrences of VF occurred in 27% of patients with early repolarization abnormality and may be life threatening. Isoproterenol in acute cases and quinidine in chronic cases are effective AADs.
Haïssaguerre
Michel
M
Université Bordeaux, CHU Bordeaux, Bordeaux, France. Electronic address: michel.haissaguerre@chu-bordeaux.fr.
Sacher
Frederic
F
Université Bordeaux, CHU Bordeaux, Bordeaux, France.
Nogami
Akihiko
A
Yokohama Rosai Hospital, Yokohama, Japan.
Komiya
Nohiriro
N
Nagasaki University, Nagasaki, Japan.
Bernard
Anne
A
Centre Hospitalier Universitaire de Tours, Tours, France.
Probst
Vincent
V
Centre Hospitalier Universitaire de Nantes, Nantes, France.
Yli-Mayry
Sinikka
S
Tampere University Hospital, Tampere, Finland.
Defaye
Pascal
P
Centre Hospitalier Universitaire de Grenoble, Grenoble, France.
Aizawa
Yoshifusa
Y
Niigata University School, Niigata, Japan.
Frank
Robert
R
Centre Hospitalier Universitaire de Paris, Paris, France.
Mantovan
Roberto
R
Treviso Hospital, Treviso, Italy.
Cappato
Riccardo
R
Policlinico San Donato, Milano, Italy.
Wolpert
Christian
C
University Hospital Mannheim, Mannheim, Germany.
Leenhardt
Antoine
A
Centre Hospitalier Universitaire de Paris, Paris, France.
de Roy
Luc
L
Clinique MontGodinne, MontGodinne, Belgium.
Heidbuchel
Hein
H
University Hospital Leuven, Leuven, Belgium.
Deisenhofer
Isabel
I
University Hospital Herzzentrum Munich, Munich, Germany.
Arentz
Thomas
T
University Hospital Bad Krozingen, Bad Krozingen, Germany.
Pasquié
Jean-Luc
JL
Centre Hospitalier Universitaire de Montpellier, Montpellier, France.
Weerasooriya
Rukshen
R
Université Bordeaux, CHU Bordeaux, Bordeaux, France.
Hocini
Meleze
M
Université Bordeaux, CHU Bordeaux, Bordeaux, France.
Jais
Pierre
P
Université Bordeaux, CHU Bordeaux, Bordeaux, France.
Derval
Nicolas
N
Université Bordeaux, CHU Bordeaux, Bordeaux, France.
Bordachar
Pierre
P
Université Bordeaux, CHU Bordeaux, Bordeaux, France.
Clémenty
Jacques
J
Université Bordeaux, CHU Bordeaux, Bordeaux, France.
D000293:Adolescent; D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000494:pharmacology* / Q000627:therapeutic use; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D007545:Isoproterenol / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D011802:Quinidine / Q000494:pharmacology*; D012008:Recurrence; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology
D000889:Anti-Arrhythmia Agents; D011802:Quinidine; D007545:Isoproterenol