Arrhythmogenic effects of antiarrhythmic drugs: a study of 506 patients treated for ventricular tachycardia or fibrillation

Krannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis 46202.

Antiarrhythmic therapy in 506 consecutive patients undergoing 1,268 antiarrhythmic drug trials for ventricular tachycardia or ventricular fibrillation was reviewed for evidence of arrhythmogenic drug effect defined as the occurrence of a new form of ventricular tachyarrhythmia temporally associated with initiation of drug therapy or dosage increase. Arrhythmogenic effects occurred in 6.9% of patients and 3.4% of drug trials. This ranged from a high of 11.8% caused by encainide to none occurring with procainamide, tocainide or beta-adrenergic blocking drugs. The incidence of arrhythmogenesis was significantly greater in patients whose presenting arrhythmia was sustained ventricular tachycardia than it was in those who presented with nonsustained ventricular tachycardia or ventricular fibrillation (p = 0.02). Decreased systolic function measured echocardiographically at the base of the left ventricle was associated with an increased incidence of arrhythmogenic effects (p = 0.006) whereas global left ventricular ejection fraction was not. Age, gender, cardiac diagnosis, location of prior myocardial infarction and New York Heart Association functional class for heart failure were not related to the occurrence of drug-induced arrhythmias. These findings emphasize the need for in-hospital cardiac monitoring during initiation of antiarrhythmic drug therapy for ventricular tachyarrhythmias.

This article has been cited by other articles:

				E. Shantsila, T. Watson, and G. Y. Lip Drug-induced QT-interval prolongation and proarrhythmic risk in the treatment of atrial arrhythmias Europace, September 1, 2007; 9(suppl_4): iv37 - iv44. [Abstract] [Full Text] [PDF]

				The International Liaison Committee on Resuscitati The International Liaison Committee on Resuscitation (ILCOR) Consensus on Science With Treatment Recommendations for Pediatric and Neonatal Patients: Pediatric Basic and Advanced Life Support Pediatrics, May 1, 2006; 117(5): e955 - e977. [Abstract] [Full Text] [PDF]

				E. S. Kaufman, P. A. Zimmermann, T. Wang, G. W. Dennish III, P. D. Barrell, M. L. Chandler, H. L. Greene, and AFFIRM Investigators Risk of proarrhythmic events in the atrial fibrillation follow-up investigation of rhythm management (AFFIRM) study: A multivariate analysis J. Am. Coll. Cardiol., September 15, 2004; 44(6): 1276 - 1282. [Abstract] [Full Text] [PDF]

				U. C. Hoppe, E. Marban, and D. C. Johns Distinct gene-specific mechanisms of arrhythmia revealed by cardiac gene transfer of two long QT disease genes, HERG and KCNE1 PNAS, April 24, 2001; 98(9): 5335 - 5340. [Abstract] [Full Text] [PDF]

				R. R. Brooks, A. P. Drexler, A. E. Maynard, H. Al-Khalidi, and D. R. Kostreva Proarrhythmia of Azimilide and Other Class III Antiarrhythmic Agents in the Adrenergically Stimulated Rabbit Experimental Biology and Medicine, February 1, 2000; 223(2): 183 - 189. [Abstract] [Full Text]

				D. S. Cannom and E. N. Prystowsky Management of Ventricular Arrhythmias: Detection, Drugs, and Devices JAMA, January 13, 1999; 281(2): 172 - 179. [Abstract] [Full Text] [PDF]

				P. P. Sharma, P. Ott, V. Hartz, J. W. Mason, and F. I. Marcus Risk Factors for Tachycardia Events Caused by Antiarrhythmic Drugs: Experience From the ESVEM Trial Journal of Cardiovascular Pharmacology and Therapeutics, January 1, 1998; 3(4): 269 - 274. [Abstract] [PDF]

				O. Hansen, B. W. Johansson, and B. Gullberg Metabolic, Hemodynamic, and Electrocardiographic Responses to Increased Circulating Adrenaline: Effects of Pretreatment with Class 1 Antiarrhythmics Angiology, December 1, 1991; 42(12): 990 - 1001. [Abstract] [PDF]

				J. Zatuchni Antiarrhythmic Proarrhythmias Angiology, July 1, 1991; 42(7): 596 - 596. [PDF]

				RISK FACTORS FOR ARRHYTHMIAS FROM ANTIARRHYTHMIC DRUGS Journal Watch (General), July 14, 1989; 1989(714): 5 - 5. [Full Text]