This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (2) Citing Articles via Google Scholar Google Scholar Articles by Haïssaguerre, M. Articles by Clémenty, J. Search for Related Content PubMed Articles by Haïssaguerre, M. Articles by Clémenty, J. Related Collections Related Articles

CLINICAL RESEARCH: HEART RHYTHM DISORDER

Characteristics of Recurrent Ventricular Fibrillation Associated With Inferolateral Early Repolarization

Role of Drug Therapy

Michel Haïssaguerre, MD^_*,_*, Frederic Sacher, MD^_*, Akihiko Nogami, MD^#, Nohiriro Komiya, MD^_**, Anne Bernard, MD, Vincent Probst, MD, PhD, Sinikka Yli-Mayry, MD^||||, Pascal Defaye, MD, Yoshifusa Aizawa, MD, Robert Frank, MD^||, Roberto Mantovan, MD, Riccardo Cappato, MD, Christian Wolpert, MD^¶¶, Antoine Leenhardt, MD^||, Luc de Roy, MD, Hein Heidbuchel, MD, Isabel Deisenhofer, MD^##, Thomas Arentz, MD^_***, Jean-Luc Pasquié, MD, PhD^¶, Rukshen Weerasooriya, MD^_*, Meleze Hocini, MD^_*, Pierre Jais, MD^_*, Nicolas Derval, MD^_*, Pierre Bordachar, MD^_* and Jacques Clémenty, MD^_*

^_* Université Bordeaux, CHU Bordeaux, Bordeaux, France
Centre Hospitalier Universitaire de Tours, Tours, France
Centre Hospitalier Universitaire de Nantes, Nantes, France
Centre Hospitalier Universitaire de Grenoble, Grenoble, France
^|| Centre Hospitalier Universitaire de Paris, Paris, France
^¶ Centre Hospitalier Universitaire de Montpellier, Montpellier, France
^# Yokohama Rosai Hospital, Yokohama, Japan
^_** Nagasaki University, Nagasaki, Japan
Niigata University School, Niigata, Japan
Treviso Hospital, Treviso, Italy
Policlinico San Donato, Milano, Italy
^|||| Tampere University Hospital, Tampere, Finland
^¶¶ University Hospital Mannheim, Mannheim, Germany
^## University Hospital Herzzentrum Munich, Munich, Germany
^_*** University Hospital Bad Krozingen, Bad Krozingen, Germany
University Hospital Leuven, Leuven, Belgium
Clinique MontGodinne, MontGodinne, Belgium

Manuscript received July 22, 2008; revised manuscript received October 8, 2008, accepted October 26, 2008.

^_* Reprint requests and correspondence: Dr. Michel Haïssaguerre, Hôpital Cardiologique du Haut-Lévêque, 33604 Bordeaux-Pessac, France (Email: michel.haissaguerre{at}chu-bordeaux.fr).

Objectives: 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 (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.

Key Words: early repolarization • sudden cardiac death • ventricular fibrillation • electrical storm • antiarrhythmic drugs

Abbreviations and Acronyms   AAD = antiarrhythmic drug   ICD = implantable cardioverter-defibrillator   IQR = interquartile range   VF = ventricular fibrillation

Related Articles

Idiopathic Ventricular Fibrillation "Le Syndrome d'Haïssaguerre" and the Fear of J Waves

Sami Viskin
J. Am. Coll. Cardiol. 2009 53: 620-622. [Full Text] [PDF]

This article has been cited by other articles:

				S. Kamakura, T. Ohe, K. Nakazawa, Y. Aizawa, A. Shimizu, M. Horie, S. Ogawa, K. Okumura, K. Tsuchihashi, K. Sugi, et al. Long-Term Prognosis of Probands With Brugada-Pattern ST-Elevation in Leads V1-V3 Circ Arrhythm Electrophysiol, October 1, 2009; 2(5): 495 - 503. [Abstract] [Full Text] [PDF]

				G. M. Marcus, E. Keung, and M. M. Scheinman The year in review of clinical cardiac electrophysiology. J. Am. Coll. Cardiol., August 25, 2009; 54(9): 777 - 787. [Full Text] [PDF]

				S. Viskin Idiopathic Ventricular Fibrillation "Le Syndrome d'Haissaguerre" and the Fear of J Waves. J. Am. Coll. Cardiol., February 17, 2009; 53(7): 620 - 622. [Full Text] [PDF]