title: Characteristics of recurrent ventricular fibrillation associated with inferolateral early repolarization role of drug therapy.
abstract: 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.
authors.affiliation: Université Bordeaux, CHU Bordeaux, Bordeaux, France. Electronic address: michel.haissaguerre@chu-bordeaux.fr.
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
authors.affiliation: Université Bordeaux, CHU Bordeaux, Bordeaux, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Sacher
authors.affiliation: Yokohama Rosai Hospital, Yokohama, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Nogami
authors.affiliation: Nagasaki University, Nagasaki, Japan.
authors.forename: Nohiriro
authors.initials: N
authors.lastname: Komiya
authors.affiliation: Centre Hospitalier Universitaire de Tours, Tours, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Bernard
authors.affiliation: Centre Hospitalier Universitaire de Nantes, Nantes, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Probst
authors.affiliation: Tampere University Hospital, Tampere, Finland.
authors.forename: Sinikka
authors.initials: S
authors.lastname: Yli-Mayry
authors.affiliation: Centre Hospitalier Universitaire de Grenoble, Grenoble, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Defaye
authors.affiliation: Niigata University School, Niigata, Japan.
authors.forename: Yoshifusa
authors.initials: Y
authors.lastname: Aizawa
authors.affiliation: Centre Hospitalier Universitaire de Paris, Paris, France.
authors.forename: Robert
authors.initials: R
authors.lastname: Frank
authors.affiliation: Treviso Hospital, Treviso, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Mantovan
authors.affiliation: Policlinico San Donato, Milano, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Cappato
authors.affiliation: University Hospital Mannheim, Mannheim, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Wolpert
authors.affiliation: Centre Hospitalier Universitaire de Paris, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Leenhardt
authors.affiliation: Clinique MontGodinne, MontGodinne, Belgium.
authors.forename: Luc
authors.initials: L
authors.lastname: de Roy
authors.affiliation: University Hospital Leuven, Leuven, Belgium.
authors.forename: Hein
authors.initials: H
authors.lastname: Heidbuchel
authors.affiliation: University Hospital Herzzentrum Munich, Munich, Germany.
authors.forename: Isabel
authors.initials: I
authors.lastname: Deisenhofer
authors.affiliation: University Hospital Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Arentz
authors.affiliation: Centre Hospitalier Universitaire de Montpellier, Montpellier, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Pasquié
authors.affiliation: Université Bordeaux, CHU Bordeaux, Bordeaux, France.
authors.forename: Rukshen
authors.initials: R
authors.lastname: Weerasooriya
authors.affiliation: Université Bordeaux, CHU Bordeaux, Bordeaux, France.
authors.forename: Meleze
authors.initials: M
authors.lastname: Hocini
authors.affiliation: Université Bordeaux, CHU Bordeaux, Bordeaux, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Jais
authors.affiliation: Université Bordeaux, CHU Bordeaux, Bordeaux, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Derval
authors.affiliation: Université Bordeaux, CHU Bordeaux, Bordeaux, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bordachar
authors.affiliation: Université Bordeaux, CHU Bordeaux, Bordeaux, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Clémenty
mesh_terms: 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
chemical_list: D000889:Anti-Arrhythmia Agents; D011802:Quinidine; D007545:Isoproterenol